RC 

206 

C6 

1898a 

PUBL 


UC-NRLF 


1 


B  ^  527  133 


A  HISTORY 


OF 


YELLOW  FEVER 


ORIGliSLAND^QVUSE 


^Iff 


And  its  present  artificially  acquired  habitat,  with  reasons  going 

to  show  the  possibiUty  of  its  complete  extinction  from 

the  globe,  its  nature,  ariatomical  characteristics, 

symptoms,  course  and  treatment  with 

an  addendum  on  its  twin  sister 


DENGUE 


Containing  a  parallel  table  of  the  most  prominent  symptoms 
of  each  disease. 


1^*4^*1^*^'' 


BY 

W.  L.  COLEMAN,  M.  D. 

Houston,  Texas, 


^ 


A  HISTORY 


OF 


YELLOW  FEVER 


tl^t^tS^t^ 


And  its  present  artificially  acquired  habitat,  with  reasons  going 

to  show  the  possibility  of  its  complete  extinction  from 

the  globe,  its  nature,  anatomical  characteristics, 

symptoms,  course  and  treatment  with 

an  addendum  on  its  twin  sister 

DENGUE 


Containing  a  parallel  table  of  the  most  prominent  symptoms 
of  each  disease* 


^2^  ^^^  %^^  9^^ 

BY 

W.  L.  COLEMAN,  M.  D. 

Houston,  Texas, 


In  compliance  with  current  copyright 

law,  U.  C.  Library  Bindery  produced 

this  replacement  volume  on  paper 

that  meets  ANSI  Standard  Z39.48- 

1984  to  replace  the  irreparably 

deteriorated  original 

2002 


DEDICATION. 


This  book  is  affectionately  dedicated  to  the 
Medical  Profession,  in  which  I  have  been  a 
hard  and  earnest  worker  forever  forty.years,  with 
the  hope  that  through  them  it  will  be  the  means 
of  accomplishing  much  good  for  my fellowmen. 

The  Author, 


% 
PUBLISHER'S  STATEMENT. 


The  Author's  manuscript  was  prepared  dur-^ 
ing  the  year  1 891  and  has  been  carefully  and  pains- 
takingly revised  in  the  office  of  publication,  to 
comply  with  the  political  conditions  now  exist- 
ing. It  is  believed  that  'the  Doctor's  predictions 
are  correct  and  that  we  shall  never  have  another 
widespread  epidemic  of  yellow  fever,  particular!)' 
if  his  suggestions  for  the  prophylactic  treatment 
herein  expressed  are  faithfully  carried  out. 
And  if  cases  do  occur  we  believe  that  the  author 
and  his  many  co-workers  will  be  able  to  demon- 
strate that  the  disease  can  be  more  successfully 
combatted  along  alkaloidal  lines  than  it  has 
ever  been  before.  We  therefore  heartily  com- 
mend the  little  book  to  all  who  would  know  the 
truth  of  the  past,  the  present  and  the  probable 
iuture  of  yellow  fever. 

The    Clinic  Publishing  Gompany. 

Chicago,  July,  1898.  v 


r 


PREFACE. 


While  the  launching  of  this  frail  little  cjaft, 
pilotless   as   it   were  and    from    an .   unknown 

jDuilder,  upon  the  literary  ocean  of  ^nedicine, 
and  especially  upon  that  part  of  that  turbulent 
sea  the  surface  of  which  has  been  so  frequently 
agitated  by  the  fiercest  and  most  bitter  wordy 
combats  and  violent  controversial  storms  con- 
cerning its  subject,  may  be  regarded  as  an  act 
of  foolhardy  temerity;  yet  although  it  is  the 
author's  first  venture  in  this  particular  depart- 
ment he  sends  it  forth  fearlessly,  utterly  ignor- 
ing and  indifferent  not  only  to  the  ^Hmprimatur'' 
of  the  celebrated  French  Academy  of  Sciences, 
so  highly  prized  and  desired  by  Dr.  Audouard, 
but  also  to  the  endorsement  of  all  the  sp-called 
scientific  societies  of  the  world,  fully  convinced 
and  well  satisfied  that  it  will  be  eagerly  sought 
for  and  read  by  that  large  and  rapidly  increas- 
ing body  of  intelligent,  progressive  physicians, 
"The  Burggraevian  Dosimetrists  of  Europe," 
and  "The  Abbott  Alkalometrists  of  America," 

^who,  being  dominated  solely  by  that  rare 
quality  of  mind,  common  sense,  ''prove  all 
things"  and  are  in  no  way  governed  by  the  old 
rule  of  /'Magister  dixit." 

I  do  not  mean  the  least  disrespect  or  dispar- 


4  PREFACE. 

agement  of  them  when  I  say  I  ignore  the  learned 
scientific  bodies  of  the  world  and  do  not  care 
the  snap  of  my  little  finger  whether  or  not  they 
read  a  line  of  my  unpretentious  little  collection 
of  irrefutable  truths  concerning  the  subject  of 
my  work.  They  ignored  Dr.  Audouard's  valu- 
able brochure  because  it  did  not  bear  the  seal  of 
the  French  Academy,  although  he  was  a  special 
representative  of  that  society  on  the  official 
commission  appointed  by  the  French  govern- 
ment in  1821-23  to  investigate  the  yellow  fever 
epidemics  of  Spain;  while  mine  is  not  only 
entirely  destitute  of  a  seal  from  any  kind  of  a 
society,  but  it  is  the  production  of  one  who 
determined  forty-five  years  lago,  when  a  student, 
to  discover  all  possible  hidden  truths  of  this 
disease  about  which  the  most  brilliant  and 
gigantic  minds  in  the  profession  had  been 
wrangling  for  nearly  a  century  without  coming 
to  a  clear  understanding  about  any  of  them. 

And  now,  without  a  scintilla  of  egotism  or 
spirit  of  boasting,  I  present  as  a  result  of  my 
labors  the  chief  of  those  old  points  of  contro- 
versy cleared  of  all  mystery  and  established 
upon  the  firm  basis  of  immutable  truth;  and 
doing  this  in  a  spirit  of  perfect  confidence  born 
of  this  result  of  my  labors,  I  demand  rather 
than  solicit,  as  authors  usually  do,  the  attention 
and  investigation  of  the  rank  and  file  of  the  pro- 
fession— that  great  body  of  hard  workers  who 
always  honestly  desire  and  earnestly   seek  for 


-  PREFACE.  5 

the  truth  in  such  questions,  well  knowing  that 
correct  diagnosis  and  successful  treatment  can- 
not be  attained  without  a  perfect  knowledge  of 
the  origin,  cause  and  nature  of  disease.  Hence 
as  it  is  to  their  interest,  I  expect  they  will  be 
my  principal  readers  and  I  trust  they  may  be 
greatly  benefited  by  my  labors;  but  whether  or 
not  I  am  mistaken  and  am  premature  in  my  pre- 
diction that  the  scourge  has. 
course,  and  that  it  will  neveF^roduce  a  general 
and  destructive  epidemic  in  this  country  again; 
yet  it  is  reasonable  to  expect  that  on  account  of 
the  present  strained  state  of  affairs  between 
Spain,  Cuba  and  our  country,  there  is  great 
danger  of  a  more  wide-spread  epidemic  of  yellow 
fever  this  summer  throughout  the  length  and 
I  breadth  of  our  land  than  ever  has  occurred  or 

[  ever  will  again  occur;  and  in  that  event,  there  will 

I  be  a  greater  number  of  this  class  of.  physicians, 

called  upon  to  treat  this  disease  than  ever  before 
[  in   its  whole   history.     Naturally    our    soldiers 

I  will  as  a  rule  be  non-immunes,  and  I  fear,  alas, 

I  that  more  of  them  will  be  cut  down  by  this  ter- 

rible  disease   than   by   Spanish   bayonets    and 
^  ^      bullets. 

It  is  under  just  such  circumstances  that  I 
hope  this  little  brochure  will  be  of  great  help  and 
benefit;  for  while  I  have  not  given  the  profession 
a  treatment  that  will  always  cure  the  disease, 
none  having  been  discovered,  yet  they  will  find 
in  this  work  advice,  directions  and  warnings  for 


6  PREFACE. 

preventing  or  modifying  it  that  cannot  be  found 
elsewhere  and  which,  if  heeded  and  carefully 
followed,  will  save  many  valuable  lives. 

Ihave  no  grounds  for  egotism  or  boasting,  as 
nearly  all  the  facts  presented  were  obtained  by 
eminent  men  all  along  the  line  down  to  the 
present;  but  I  have  been  enabled  by  the  evi- 
dence of  subsequent  historical  events  to  use 
these  facts  in  deducing  and  establishing  truths 
which  they  could  not  see  for  want  of  this  later 
evidence,  thus  proving  Audouard's  theory  to  be 
no  longer   theory  but  a  stern,  irrefutable  truth. 

W.  L.  C. 

Houston^  Texas,  U.  S.  A. 


INTRODUCTION. 


"To  all  facts  there  are  laws; 

The  efifect  has  its  cause,  and  I  mount  to  the  cause." 

—Lucile. 

The  world  is  too  busy  to  form  its  opinion  on 
a  question  at  first  hand;  hence  important  his- 
torical facts  and  truths  are  seldom  recognized 
or  understood  by  people  of  the  age  in  which 
-  they  occur,  for  some  are  at  times  suppressed 
before  suitable  knowledge  is  obtained  of  them, 
some  for  political  and  some  for  commercial 
reasons  and  yet  others  from  bigotry;  so  it 
\  requires   time  for  these  different  objections  to 

I  pass   away,    as   well   as   for   the    corroborative 

I  evidence  of  subsequent  events  to  establish  them 

\  beyond   question   as   facts  and   truths.     In  the 

[  course   of  this  paper  I  will  mention  a  marked 

\  instance  of  the  suppression  of  truth  for  each  of 

I  the  aforesaid  reasons,  and  thus  show  that  even 

j  medical  men  are  often  blinded  to  the  truth  by 

their  prejudices  and  passions.     We  of  all  men 
i  should  be  liberal-minded,   free  from    bias  and 

\:  bigotry  and  incapable  of  being  swayed  by  polit- 

1  ical,  commercial,   religious  or  other  influences 

that  tend  to  obscure  or  suppress  truth. 

I  have  been  intending  for  some  time  past  to 

I  undertake  the  task  of  collecting  and  arranging 

;  for  publication  the  records  of  facts  and  truths 

that   I   have  obtained   by  personal  experience, 

I  observation    and    investigation   of   yellow  fever 


8  INTRODUCTION. 

during  more  than  forty  years,  together  with 
everything  else  of  interest  and  scientific  value 
that  r  have  obtained  from  reliable  sources  which 
would  help  to  make  a  correct  history  of  the  dis- 
ease. But  procrastination  has  been  the  bane  of 
my  life^  and  I  fear  I  have  delayed  the  work  till 
it  is  too  late  to  accomplish  it  in  a  manner  that 
will  render  it  interesting  and  profitable  to  the 
present  and  future  generations  of  medical  men. 
My  feeble  condition  and  rapidly  failing  strength 
warn  me  that  but  little  time  is  left  in  which  to 
work.  Would  that  some  younger  and  more 
fitting  hand  and  brain  had  the  task  ! 

In  the  beginning  of  my  medical  -  studies  a 
fascination  for  the  subject  of  yellow  fever  took 
possession  of  my  mind  and  I  have  never  been 
able  to  wholly  shake  it  off.-  During  many  weary 
years  of  study  I  wandered  blindly  through  the 
mazy  labyrinth  of  mysteries  surrounding  it, 
seeking  light  and  truth  but  finding  none.  At 
the  point  of  despair  I  was  led  from  that  state  of 
uncertainty  by  a  ray  of  light  emanating  from  a 
gem  of  truth  seventy-five  years  old  which  reached 
my  dull  brain  by  penetrating  through  the  preju- 
dice and  passion  that  had  resisted  its  entrance 
for  forty  years;  and  I  set  to  work  to  bring  order 
out  of  the  chaos  of  facts  and  truths  which  had 
been  gathered  by  myself  and  others  during  the 
past  history  of  this  horrible  scourge. 

The  two  greatest  barriers  to  the  reception  of 
truth,  prejudice   and   passion,  having  been  re- 


INTRODUCTION.  9 

moved,  it  became  easy  to  accept  and  understand 
the  plain  solution  of  the  etiological  "x"  in  the 
problem  stated  by  Dr.  Audouard  seventy-five 
years  before  and  to  see  its  complete  verification 
by  every  event  in  the  subsequent  history  of 
every  thing  connected  with  the  subject.  It  was 
about  this  vexed  point  that  some  of  the  fiercest 
and  most  violent  controversial  storms  raged  that 
ever  disturbed  the  medical  mind;  while  the  ques- 
tion of  its  contagion,  nature  and  connection 
with  malarial  fever  came  in  for  their  share;  in 
the  controversies  which,  with  each  recurring 
epidemic,  were  indulged  in  by  the  giants  of  the 
profession  from  the  days  of  the  great  Benjamin 
Rush  down  to  those  of  Doctors  La  Roche  and 
Warren  Stone. 

Surveying  those  wordy  contests,  which  were 
conducted  with  so  much  heat  and  passion  of 
argument^  by  the  light  derived  from  the  knowl- 
edge of  its  true  origin,  shows  them  to  have  been 
supremely  ridiculous;  for  it  reveals  the  ignorance 
of  both  parties  concerning  the  question  under 
discussion  in  which  both  claimed  to  be,  and 
honestly  thought  they  were,  exactly  right.  It 
was  always  a  mystery  to  me  why  they  so  stub- 
bornly adhered  to  their  respective  opinions,  for 
they  were  men  eminent  in  the  profession  who 
readily  yielded  to  reason  upon  other  subjects. 
The  mystery  has  been  cleared  up  by  the  n^w 
light,  the  knowledge  of  which  however  lay  hid- 
den  for   nearly  seventy-five  years;   and   in   the 


INTRODUCTION. 


course  of  my  discussion  of  that  point  it  will 
readily  be  shown  that  both  parties  were  right  at 
that  time,  however  paradoxical  this  assertion 
now  seems.  -       - 

For  more  than  two  centuries  this  unique  dis- 
ease was  an  unsolved  mystery  standing  solitary 
and  alone,  as  has  been  said  of  the  great  Napo- 
leon, ''grand,  gloomy  and  peculiar,  wrapped  in 
the  solitude  (mystery)  of  his  own  originality." 
Claiming  no  land  as  its  birth  place  (and  it  never 
has  originated  de  novo)  it  is  absolutely  and 
wholly  a  filth  disease,  a  specific  animal  poison 
of  peculiar  filth,  born  or  generated  upon  the  high 
seas  and  under  peculiar  conditions  (which  have 
ceased  to  exist),  as  a  result  of  man's  violation 
of  Nature's  immutable  laws  and  the  inexorable 
fiat  of  their  Author  that  the  violation  of  one 
natural  law  brings  its  own  punishment  by 
setting  into  active  operation  another  law  govern- 
ing the  changed  condition.  It  can  truly  be  said 
to  be  ''the  pestilence  that  walketh  in  darkness, 
the  destruction  that  wasteth  at  noon  day;"  and 
after  years  of  study  and  investigation  of  this 
scourge  I  can  come  to  no  other  conclusion  but 
that  it  is  a  Nemesis,  an  agent  of  retributive 
justice  in  the  hands  of  Him  who  hath  said 
"Vengeance  is  mine,  I  will  repay."  But  since 
the  cruel  traffic  to  which  it  owes  its  origin  has 
long  since  ceased,  and  the  institution  of  slavery, 
of  which  J.  K.  Ingram  said  (Encyclopedia 
Britannica — "Slavery"):     "It  was  politically  as 


INTRODUCTION.  H 

well  as  morally  a  monstrous  aberration,  and  never 
produced  anything  but  evil,"  has  been  abolished 
by  all  the  nations  of  the  earth,  I  have  believed  that 
this  instrument  of  punishment  would  also  be  re- 
moved. After  finishing  my-work  in  Memphis  in 
1819  I  predicted  that  there  would  never  be  an- 
other serious  and  widespread  epidemic  of  this 
disease  in  this  country;  for  I  had  the  presump- 
tion to  think  that  the  South  had  received  its  full 
meed  of  punishment  for  the  part  it  took  in  that 
great  sin,  that  is,  if  we  reckoned  in  the  estimate 
the  horrors  of  the  four  years  of  civil  war  as 
legitimate  results;  while  the  North  received  its 
portion  from  1693,  the  date  of  its  first  appear- 
ance in  this  country,  down  to  1822,  since  when 
its  visits  to  that  region  have  been  few  and  far 
between  and  confined  to  small  areas. 

In  the  following  history  of  yellow  fever  I  hope 
to  be  able  to  establish  as  an  irrefutable  truth 
Dr.  Audouard's  theory  of  its  origin,  and  thereby 
refute  and  show  the  littleness  of  the  damaging 
epithet  of  Prof.  Hirsch  who,  in  describing  it  in 
his  treatise  on  **  Geographical  and  Historical 
Pathology,"  characterized  it  as  '*eine  der 
abenteuerlichsten  hypothesis,"  a  Quixotic  idea 
unworthy  of  credence.  And  I  think  it  appro- 
priate to  remark  just  here,  if  I  succeed  in  this 
object,  that  the  Royal  Medico-Chirurgical  So- 
ciety of  London,  in  whose  library  a  copy  of 
Audouard's  book  lay  with  uncut  leaves  for  sixty 
years,    certainly  owes  it  to  his  memory  and  to 


12  INTRODUCTION.     . 

the  medical  profession  in  general  to  resurrect 
and  republish  his  work  as  a  partial  reparation 
-for  their  neglect  and  quasi  suppression,  for  more 
than  half  a  century,  of  a  book  containing  a  truth 
as  grand  and  useful  as  any  other  discovered 
during  this  wonderful  nineteenth  century. 

Before  going  into  the  chronological  history  of 
yellow  fever,  I  deem  it  necessary  for  a  clear 
understanding  of  my  design  to  give  my  views 
and  final  conclusions  in  regard  to  this  disease. 

1.  Yellow  fever  is  not  native  to  any  conti- 
nent of  the  old  or  new  world,  and  never  per  sc 
originated  de  novo  upon  any  spot  of  land  upon 
the  globe. 

2.  Yellow  fever  is  a  specific  disease  peculiar 
to  itself;  and  while  there  are  several  apparently 
analogous  diseases,  yet  it  stands  separate  and 
distinct  from  all  others.  It  is  always  identical 
in  every  climate  where  4t  prevails  and  is  not  a 
grade  or  type  of  malaria  or  other  zymotic  fevers. 

3.  Yellow  fever  is  pre-eminently  a  filth  dis- 
ease .  caused  by  a  specific  infection  or  animal 
poison  generated  from  a  peculiar  fifth  and  un- 
der peculiar  conditions,  and  possessing  a  germ 
capable  of  transportation  and  reproduction. 

4.  Yellow  fever  is  never  contagious  but  is 
highly  infectious;  and  its  germs,  while  unlimited 
as  to  quantity,  are  limited  to  two  stages  of  exist- 
ence in  their  power  of  reproduction. 

5.  When  this  germ  resulting  from  that  spe- 
cific poison   is  introduced  into  a  locality  where 


L-^4*^X^^v^^^    ' 


1       / 
E 


INTRODUCTION. 


13 


where  the  unsanitary  conditions  and  the  meteor- 
ological stage  of  the  atmosphere  are  suitable  for 
its  existence  and  propagation,  the  second  stage 
is  ushered  in  by  the  production  of  the  true 
pathogenic  microbe  of  yellow  fever  in  such 
quantities  and  numbers  as  to  fill  the  atmosphere 
of  that  region  as  far  as  the  suitable  conditions 
extend.    - 

6.  When  a  sufficient  portion  of  this  specific 
poison  once  enters  the  human  organism  and 
produces  its  characteristic  phenomena,its  vitality 
ceases  and  it  becomes  so  innocuous  that'a  healthy 
person  may  drink  the  blood  or  be  inoculated 
with  the  black  vomit  or  other  secretions  and 
excretions  of  a  fatal  case  of  yellow  fever  with 
impunity,  thus  verifying  the  teaching  of  thou- 
sands'of  observations  and  centuries  of  experi- 
ence that  personal  contagion  in  this  disease  is 
an  impossibility. 

7.  For  the  same  reason  what  are  known  as 
h^ibernating  germs  or  microbes,  or  those  which 
have  failed  to  find  a  field  in  which  to  propagate 
and  at  the  end  of  the  epidemic  are  so  favorably  sit- 
uated as  to  have  their  vitality  and  virulence  pre- 
served from  destruction  by  the  cold  of  the  suc- 
ceeding winter,  can  only  produce  sporadic  cases 
the  following  season-^-never  an  epidemic.  1 
have  witnessed  numerous  examples,  after  various 
epidemics,  which  go,  to  establish  this  position- 
beyond  question,  besides  having  the  testimony 
of  reliable  physicians  to  the  same  effect;  in  fact 


14  INTRODUCTION.  1 

it  is  plain  that  if  the  preceding  proposition  is 
true,  this  necessarily  follows  as  a  natural  and 
logical  sequence. 

8.  And  finally:  the  peculiar  filth  which  orig- 
inally gave  rise  to  the  specific  infection  of  yellow 
fever  was  for  nearly  two  centuries  deposited  in 
a  number  of  the^  harbors  of  our  Atlantic  sea- 
board and  in  the  alluvia  of  the  Mississippi  at 
New  Orleans,  and  this  in  quantities  sufficient  to  i 

feebly  naturalize  or  render  it  indigenous  to  these 
localities.     But    the    rushing,     rolling,    raging  1 

billows    and    the    fierce,  passionate,    pitching,  I 

plunging  tides  of  the  Atlantic  have  long  since  ^ 

washed  every  trace  of  it  from  the  mud  of  every  | 

American  port  from  Cape  Cod  to  the  Cape  of  j 

Florida;   while   the   massive   volume   of    water  J 

annually  rolling  down  the  Mississippi  has  cleared        1   ; 
it  out  of  the  port  of  New  Orleans  where  it  has    . 
been  more  frequently  claimed  to  be  indigenous 
than  at  any  other  point  on  our  continent;  hence 
the  value  of  strict  and  perfect  coast-line  quaran- 
tine. .  „ 


i 


PART    I 


ORIGIN  AND  CAUSE. 

"Felix  qui  rerum  potuit  cognoscere  causas."— F/rf//. 

Perhaps  no  disease  in  the  annals  of  medicine 
exhibits  so  many  unique  and  remarkable  facts 
in  pathology  or  has  elicited  as  many  fierce  con- 
troversies   and   differences    of   opinion    as    has 
j  yellow  fever.     These  hotly  debated  controversies 

;  as  to  its  nature  and  origin,  more  especially  the 

[  latter,  have  been  conducted  and  engaged  in  by 

I  some    of   the   most  brilliant  medical  minds  of 

(  America  from  the  days  of  Rush,  Physick   and 

[  Currie   down    to    those   of    Laroche,    Dickson, 

\  Campbell,  Warren  Stone  and  others. 

\  Until  1766  there  seems  to  have  been  no  dis- 

i  ....  ... 

!  agreement  m  the  profession   as   to   its    origin, 

':     -        being  always  regarded  as  an  imported  disease; 

and  by  common  consent  its  home  was  located 

exclusively  in   the  West  Indies  in  general,  and 

I  in  Havana  in  particular.     But  the  earliest  his- 

1  torians  of  those  islands  ascribe  its  origin  to  the 

I  East,  and  for  many  5^ars  from  its  first  appear- 

j  ance  there  it  was  known  as  the  ''mal  de  Siam,^' 

1  Subsequent  history  proves  those  writers  to  have 

i  been  perfectly  correct  as  to  the  direction  whence 

!  this  terrible  scourge  came;  but  they  located  its 


i6  YELLOW   FEVER. 

brrth-place  too  far  east,  for  neither  Asia  nor 
Africa  can  be  truthfully  charged  directly  with 
its  origin. 

In  my  opinion,  formed  from  a  careful  study 
and  review  of  the  whole  history  of  yellow 
fever,  ther^  could  be  no  more  appropriate  place 
for  its  original  home  on  this  little  globe  than 
the  notorious  '^middle  passage"  with  all  its 
attendant  atrocious  horrors. 

The  "facts"  about  which  those  giants  in  the 
medical  profession  wrangled  and  contended  so 
earnestly  during  the  last  quarter  of  the  eighteenth 
century  are  now  proven  to  be  errors,  at  least 
most  of  them;  while  a  few,  which  were  facts  in 
truth,  have  ceased  to  exist  from  removal  of  their 
cause,  thus  showing  that  facts  as  we  see  and 
comprehend  them  are  not  always  final  truths. 
"Truth  is  immutable  and  eternal,"  yet  often  the 
truth  (supposed)  bf  today  is  the  error  of 
tomorrow.  At  the  proper  time  I  hope  fo  be 
able  to  make  good  my  promise  to  show  clearly 
to  every  unprejudiced  mind  that  both  parties  in 
those  fierce  controversies  were  right  at  that 
time  but  would  not  be  so  now. 

Yellow  fever  in  its  history  has  been  so  inti- 
mately connected  with  the  old  African  slave 
trade  in  its  rise  and  decline,  both  as  to  time  and 
place,  not  only  at  the  pof  ts  of  debarkation  in , 
the  Western  but  also  in  the  ports  of  the  Eastern 
Hemisphere  where  the  disease  prevailed  so  vio- 
lently whenever  one  of  these  vile,  filthy  ships 


i-  ■ 


YELLOW  FEVER.  17 

cast  anchor  in  the  harbor  on  the  return  trip, 
tliat  the  history  of  the  one  necessarily  involves 
that  of  the  other.  This  singular  but  constant 
association  of  the  two  strangely  seems  to  have 
been  entirely  overlooked  by  all  the  early  as  well 
as  the  later  writers  upon  the  disease.  Nor  has 
any  one  of  them,  so  far  as  I  know,  noticed  or 
made  special  mention  of  the  decline  and  disap- 
pearance of  yellow  fever  from_ our  most  impor- 
tant northern  ports  as  soon  as  the  legitimate 
slave  trade  was  abolished,  where  it  had  pre- 
vailed frequently  and  virulently  for  more  thaji  a 
century  after  its  first  appearance  in 'Boston  in 
1693.  These  places,  wherever  the  disease  had 
occurred,  had  also  been  ports  of  debarkation  for 
the  slave  ships  during  the  long  period  when  the 
trade  was  recognized  as  legitimate  and  carried 
on  principally  by  England. 

For  nearly  Iwo  centuries  the  fouly  iermenting 
and  putrefying  d3^senteric  discharges, along  with 
other  filth  from  the  poor  negroes  which  accumu- 
lated in  the  holds  and  poisoned^  the  bilges  of 
hundreds  of  slave  ships,  had  been  pumped  out 
to  mix  with  the  mud  of  those  harbors.  The 
quantity  of  this  peculiar  filth  finally  became 
sufficient  to  give  rise  to  yellow  fever,  thus  render- 
ing it  feebly  indigenous  and  endemic  at  those 
ports  till  the  traffic  ceased.  When  the  traffic 
was  abolished  and  those  ships  therefore  ceased  to 
arrive,  yellow  fever  also  disappeared  from  these 
ports  but  could;  yet  be  found  associated  else- 


i8  YELLOW   FEVER. 

where  with  the  same  traffic  which  had  .-now 
fallen  into  the  hands  of  contrabands. and  was 
carried  on  by  stealth;  and  as  those  contraband' 
ships  sought  ports  only  where  their  cargoes 
were  wanted,  the  disease  accompanied  them  to 
our  southern  ports,  the  gulf  ports  of  Mexico  and 
the  South  Atlantic  ports  of  Brazil. 

This  plain  and  indisputable  historical  fact 
seems  to  have  attracted  but  little  notice  and 
elicited  but  little  comment  in  the  past  from 
the  historians  of  yellow  fever.  This  oversight 
emphasizes  my  first  statement  that  sucji  facts 
are  seldom  recognized  and  understood  at  the 
time  of  their  occurrence;  and  sufficient  time  must 
elapse  for  the  passions  and  prejudices  against 
them  to  subside  and  pass  away  before  they  can 
be  looked  at  in  the  right  light  and  established 
as  truths.  But  the  greatest  oversight  of  all  was 
in  regard  to  the  fearful  epidemics  which  ravaged 
the  ports  of  Spain  during  the  first  quarter  of  this 
century,  causing  the  death  of  over  one  hundred 
and  forty  thoiisand  persons  in  the  one  year  of 
1804.  So,  in  my  opinion,  any  period  prior  to 
the  great  epidemics  of  1878-79  which  occurred 
in  the  Mississippi  Valley  from  New  Orleans  to 
Memphis  was  too  early  in  which  to  write  the 
correct  history  of  yellow  fever,  a  disease  which 
I  confidently  believe  to  be  now  making  the  final 
chapter  in  its  history. 

The  first  authentic  appearance  of  yellow  fever 
was   in   1647,  shortly  after  the  first  arrivals  of 


YELLOW   FEVER.  19 

slave  ships  in  the  West  Indies,  a  terrible 
epidemic  occurring  at  Bridgetown,  Barbadoes,' 
an  English  possession  and  settlement.  It  was 
spoken  of  at  that  time  as  "a.  new  disease"  and 
as  '*ari  absolute  plague,  very  infectious  and 
destructive."  But  the  Jesuit  narratives  of  the 
period  of  Columbus  describe  a  similar  fever  of  a 
malignant  type,  attended  with  yellowness  of 
skin  and  very  fatal  to  the  newly  arrived  Euro- 
peans, prevailing  epidemically  in  St.  Domingo 
and  other  islands  in  1494,  1514,  1568,  and  in 
Central  America  in  1596,  and  among  the  Indians 
of  New  England  in  1618.  Some  writers  on  the 
subject  claim  these  epidemics  to  have  been 
genuine  yellow  fever;  but  there  being  no  account 
of  these  fevers,  except  by  non-professionals,  the 
large  majority  of  reliable  historians  oppose  this 
view  and  have  agreed  upon  1647  as  the  date  of 
the  first  authentic  record.  It  was  not  till  1691, 
after  the  arrival  at  Martinique  of  the  Oriflamme 
and  two  other  vessels  loaded  with  French  colo- 
nists fleeing  from  Siam  on  account  of  an  insur- 
rection, ^at  it  was  first  called  the  "ma/  de 
Siam''  and  was  so  designated^for  many  years 
thereafter. 

The  true  history  of  these  three  vessels  prior 
to  that  trip  would  be  a  very  interesting  as  well 
as  useful  subject  for  investigation;  for  it  would 
be  strong  corroborative  evidence  in  favor  of  the 
truth  of  Audouard's  theory  if  the  records  would 
show  that  they  had  been  old  slavers.     There  are 


20  YELLOW   FEVER. 

good  grounds  for  the  belief  that  such  was  the 
fact,  but  I  am  unable  at  this  writing  to  find  the 
record  of  my  authority  for  this  statement. 
)  Its  first  appearances  in  the  United  States 
were  at  Boston  in  1693,  in  Philadelphia  and 
Charleston,  South  Carolina,  in  1699,  and  in 
New  York  in  1*702;  and  from  the  first  named 
date,  1693,  down  to  1879,  a  period  of  185  years, 
there  were  115  epidemic  years  in  which  the 
disease  visited  338  different  cities  and  towns  in 
this  country,  many  of  them  repeatedly  and  some 
almost  every  year  of  its  appearance.  New  York, 
Philadelphia  and  Charleston,  South  Carolina, 
were  visited  most  frequently  during  the  period 
of  the  so-called  legitimate  slave  trade;  they 
being  the  greatest  centers  of  population  were 
the  principal  ports  of  debarkation  for  the  miser- 
able captives.  Its  most  frequent  and  regular 
visits  were  during  the  contraband  slave  trade 
from  1808,  the  date  of  the  abolition  of  the  legiti- 
mate traffic,  down  to  1860,  a  period  of  fifty-two 
years.  During  this  period  it  failed  to  appear  in 
two  years  only,  viz.,  1813  and  1836.  ^  And  the 
record  shows  the  significant  fact  that  the  first 
named  cities.  New  York  and  Philadelphia,  were 
practically  exempt  during  that  period  and  that 
the  disease  appeared  almost  exclusively  at  X)ur 
southern  ports  into  which  those  illegal  vessels 
easily  gained  surreptitious  entrance  because 
their  cargoes  were  in  such  demand.  Comment 
is  unnecessary  upon  the  above  significant  and 


i  - 


YELLOW   FEVER.  21 

undeniable  facts;  for  they  zxe^  prima  facie  evidence 
of  such  a  close  and  constant  connection  between 
the  slave  trade  and  yellow  fever  as  to  force  us 
to  the  unavoidable  conclusion  that  the  relation 
was  one  of  cause  and  effect. 

All  the  facts  presented  by  the  history  of  the 
disease  since  1860  go  to  strengthen  and  confirm 
the  above  conclusion;  and  it  is  plain  to  be  seen 
by  any  one  who  has  closely  watched  the  course 
of  yellow  fever  for  the  last  forty  years  that  it  has 
disappeared  from  the  harbors  of  the  United 
States  as  an  indigenous  disease;  and  the  natural 
inference  is  that  this  is  the  result  of  the  cessa- 
tion of  the  annual  addition  of  the  peculiar  filth 
from  the  holds  of  African  slave  ships  to  the  mud 
of  those  harbors.  If  I  thought  it  would  be 
deemed  necessary  or  demanded  by  the  profes- 
sion I  could  easily  give  the  names  of  all  the 
places  visited,  with  date  and  mortality  of  each; 
but  it  would  require  fifteen  or  twenty  pages  of 
names,  dates  and  totals,  which  would  be  dry 
reading  and  useless  except  for  reference.  It  is 
on  record  and  can  be  found  in  several  histories 
of  yellow  fever  and  I  therefore  will  omit  it. 

Yellow  fever  visited  Cadiz,  Spain,  in  1705, 
the  first  authentic  record  of  its  appearance  in 
Europe;  and  yet  the  venerable  Dowell,  who  was 
my  personal  friend  and  whose  memory  I  revere, 
says  in  his  immense  volume  on  yellow  fever 
(which  by  the  way  contains  many  absurd  and 
unwarranted  assertions  and  contradictions):    *'It 


22  YELLOW  FEVER. 

was  undoubtedly  introduced  from  Africa  to 
America.  [No  reason  or  authority  given  for  this.] 
That  it  existed  in  Africa,  eastern  Asia  and 
southern  Europe  long  before  the  establishment 
of  the  Greek  and  Roman  empires  is  generally 
well  established  by  Hertardo,  even  running 
back  a  thousand  years  before  Christ;  that  it  has 
become  endemic  alongthe  coasts  of  Africa,  both 
east  and  west,  as  well  as  in  the  West  Indies  and 
northern  coast  of  South  America,  and  that  in 
all  these  districts  it  has  its  epidemic  years  and 
its  years  of  nearly  entire  exemption,  is  also  well 
known." 

But  Dowler,  who  is  considered  better  authority, 
says:  ''The  slightest  notice  of  yellow  fever  is 
nowhere  found  among  ancient  writers,  although 
they  have  not  failed  to  record  incidently  or 
directly  the  time,  place  and  progress  of  numerous 
epidemics  with  more  or  less  particularity,  so 
that  their  characteristics  may  now,  after  the 
lapse  of  centuries,  be  ascertained." 

Yellow  fever  does  not  appear  to  have  been 
noticed  until  after  the  discovery  of  America  by 
Columbus.  Had  it  prevailed  in  ancient  times, 
its  prominent  features,  so  very  remarkable  at 
least  in  its  advanced  stages,  would  doubtless 
have  been  recorded.  From  1705  to  1808  it 
visited  Cadiz  nine  times,  but  after  that  it  broke 
out  and  raged  like  a  prairie  fire  all  along  the 
coast  of  Spain,  appearing  frequently  at  all  the 
important    ports   till     1823.     Why    was    Spain 


YELLOW  FEVER.  23 

alone  of  all  Europe  thus  scourged?  Because 
she  was  the  first  nation  to.  inaugurate  the 
African  slave  trade  and  the  last  to  abandon  it; 
because  the  contraband  ships  were  nearly  all 
owned  by  her  citizens  and  the  illicit  trade  was 
thus  virtually  carried  on  by  her  tacit  permission, 
which  gave  easy  entrance  into  her  ports  for 
these  vessels  and  which  was  denied  them  at 
the  ports  of  all  the  other  nations;  and  so  they 
came  on  the  round  voyage  from  Africa  to  the 
West  Indies  or  the  Brazils  and  back  laden  with 
the  products  of  those  countries — cotton,  sugar, 
tobacco,  etc.;  and  although  they  generally  came 
with  "clean  bills  of  health"  from  Havana  or 
Rio,  yet  their  holds  were  reeking  with  the 
peculiar  filth  that  gave  rise  to  this  Nemesis-like 
scourge.  It  is  estimated  that  the  population  of 
Spain  was  diminished  one  million  by  this  disease 
alone;  the  official  report  of  deaths  from  yellow 
fever  for  one  year  amounted  to  one  hundred  and 
twenty-four  thousand. 

The  disease  spread  to  a  greater  extent  in  the 
interior  than  it  ever  did  in  any  other  .country, 
visiting  twenty-five  cities  and.  towns  in  the  year 
1804.  In  some  of  these  the  number  of  persons 
affected  amounted  to  1  in  27*78  of  the  population; 
and  the  average  proportion  of  deaths  to  the 
number  afflicted  was  1  in  3.087,  the  extremes 
being  1  in  1.3  and  1  in  6.42.  The  extreme 
virulence  of  the  disease  and  the  great  mortality 
was  undoubtedly  due  to  the  fact  of  the  specific 


Pi 


24 


YELLOW  FEVER. 


poison  coming  directly  from  the  holds  of  those 
slave  vessels  which  were  never  properly  cleaned; 
and  thus  Spain  received  her  full  meed  of.  pun- 
ishment for  the  part  she  took  in  this  great  crime 
against  humanity. 

The  oversight  of  yellow-fever  historians  and 
of  the  profession  generally  in  the  matter  of  the 
Spanish  epidemics  forcibly  illustrates  how  super- 
ficial we  are  at  times  in  our  observations  and 
investigations  of  a  subject;  for  although 
Audouard  pointed  out  the  path  of  truth  in  1825 
and  the  facts  in  the  case  are  now  historical  and 
as  plain  as  day-light,  yet  no  attention  has  been 
paid  them  and  little  or  no  importance  attached 
to  them.  The  facts  to  which  I  refer  are  all 
included  in  Audouard's  discovery  made  while 
officially  investigating  the  epidemic  in  1821  and 
1823,  viz. :  The  cause  of  the  prevalence  and  final 
disappearance  of  yellow  fever  from  the  coast  of 
Spain.'  And  I  add,  why  were  these  particular 
ports  thus  scourged  while  the  rest  of  Europe 
escaped? 

It  is  true  that  Dr.  Audouard's  report  pf  his 
discovery  and  his-essays  containing  his  theory 
were  ignored  and,  to  a  certain  extent,  suppressed 
by  the  French  Academy  of  Science  by  the  with- 
holding of  their  ^  Hinprvnaiur''-  for  political  rea- 
sons, fearing  to  offend  England;  and  so  his  book 
was  shelved  in  the  libraries  of  the  scientific 
societies  where  it  lay  with  uncut  leaves  and 
covered  with  dust  for  more  than  half  a  century. 


YELLOW  FEVER.  25 

positive  evidence  that  not  a  single  officer  or 
fellow  of  those  learned  bodies  ever  read  a  line 
of  it.  But  there  was  still  another  reason  why 
Audouard's  theory  attracted  so  little  attention  in 
Europe;  and  that  was  that  those  terrible  epi- 
demics of  yellow  fever  in  Spain  were  over, 
having  ceased  with  the  removal  of  the  cause; 
and  thus  the  danger  of  future  epidemics  being 
also  removed,  all  interest  in  the  disease  ceased 
and  no  future  investigations  were  made  because 
they  contended  that  it  was  a  disease  wholly  of 
the  Western  Hemisphere  and  that  it  always  had 
been  imported  whenever  it  had  prevailed  in  the 
Eastern/never  having  originated  at  any  time  or 
place  on  that  side  of  the  globe.  But  the  first 
historical  reference  to  yellow  fever  ascribes  its 
origin  to  the  East;  and  even  down  to  the  present 
time  there  is  a  vague  idea  in  the  minds  of  med- 
ical men  that,  though  it  had  become  domes- 
ticated and  indigenous  in  the  West  Indies,  it 
originally  came  from  Asia,  the  home  of  so  many 
dreadful  plagues. 

A  calm  and  impartial  review  of  the  history  of 
the  disease  reveals  the  fact  that  there  is  no 
ground  to  sustain  either  opinion;  and  it  now 
devolves  upon  me  to  state  the  facts  and  reasons 
for  my  opinion  that  it  never  originated,  upon 
land  but  that  it  was  born  upon  the  sea.  I  do 
not.  mean  by  this  that  it  was  born  or  generated 
originally  in  the  sea  water  itself,  though  it  seems 
to  have  become  an  aquatic  bug  in  its  artificially 


26  YELLOW  FEVER. 

acquired  habitat.  The  only  spot  on  earth  where 
it  can  now  be  truly  said  to  be  indigenous  and  cap- 
able of  constant  reproduction,  is  in  the  foul  and 
offensive  waters  of  the  low  land-locked,  almost 
tideless  and  stagnant  Bay  of  Havana,  with  its 
one  single,  narrow  outlet.  We  will  discuss  this 
point  more  fully  later  on;  but  let  us  now  take  a 
map  of  the  world  and  paint  a  yellow  dot  where- 
ever  yellow  fever  has  been  known  to  prevail  in 
the  past,  beginning  where  it  first  appeared  on 
our  Atlantic  seaboard  and  has  since  disappeared, 
using  the  lightest  shade  and  deepening  the  color 
as  we  trace  it  in  close  companionship  with  the 
slave  traffic,  declining  southward  until  we  reach 
our  gulf  ports  and  the  West  India  Islands, 
where  the  deepest  shade  must  be  used  to  indi- 
cate that  there  it  still  exists.  A  few  Mexican 
and  South  American  ports  must  also  be  colored; 
but  crossing  to  the  Eastern  Hemisphere,  Europe 
requires  no  paint  except  at  certain  ports  in 
Spain  already  mentioned.  Africa  requires  only 
two  or  three  small  dots  on  its  western  coast 
where  slave  ships  trafficked  and  obtained  their 
cargoes,  while  Asia,  long  supposed  to  be  its 
original  home,  takes  no  paint  at  all.  It  has 
often  been  asked  why  the  ports  on  our  Pacific 
seaboard  were  never  visited  by  the  scourge,  and 
the  only  rational  answer  is  that  slave  ships  never 
traded  on  that  coast.  The  only  points  on  the 
whole  line  of  the  Pacific  seaboard  where,  the 
yellow  fever  ever  did  obtain  a  foothold  were  Cal- 


YELLOW   FEVER.  27 

lao  and  Lima,  Peru,  in  1853;  and  its  outbreak  at 
these  points  is  strong  corroborative  proof  of  the 
truth  of  Audouard's  theory.  It  was  universally 
ascribed  to  the  arrival  of  filthy  ship-loads  of 
Chinese  coolies  who  were  brought  over  by  con- 
tract, as  the  Africans  had  been,  in  badly 
equipped  and  over-crowded  ships  and  most  of 
them  suffering  terribly  with  dysentery.  And 
as  Audouard  reasoned  in  the  case  of  the 
Africans  that  the  specific  poison  which  caused 
yellow  fever  having  come  from  the  negro  body 
could  not  poison  the  negro  again,  not  being 
auto-inoculable,  therefore  he  was  exempt  from 
the  disease,  so  it  was  found  that  the  Chinese  in 
Peru  were  as  much  immune  from  yellow  fever 
as  the  negroes  on  the  Atlantic  Coast. 

The  intimate  association  and  close  connection 
of  yellow  fever  with  the  slave  traffic  is  clearly 
shown  by  a  glance  at  our  colored  map;  for 
nearly  all  the  yellow  spots  are  on  our  Atlantic 
seaboard  and  at  northern  points  which  were  the 
first  ports  of  debarkation  for  the  slave  ships 
during  the  period  of  the  legitimate  traffic  cover- 
ing more  than  a  century  because  the  centers  of 
population  at  that  time  were  all  in  the  New 
England  and  Middle  States.  It  is  true  the  first 
authentic  epidemics  occurred  in  the  West  Indies 
in  1647  shortly  after  the  arrival  of  slave  ships 
there,  and  fifty  years  prior  to  its  first  appearance 
on  our  continent  at  Boston,  in  1693,  after  Eng- 
land had  begun  to  supply  her  American  colonies 


YELLOW   FEVER. 

with  African  slaves.  But  it  must  be  remembered 
that  Spain  was  the  first  civilized  nation  to  use 
Africans  as  slaves;  and  she  first  supplied  her 
West  India  possessions  with  them  by  contracts 
with  other  powers,  she  having  been  interdicted 
by  Pope  Alexander  VI  (1493)  from  going  east  of 
a  certain  meridian.  So  as  African  slavery  was 
first  established  in  the  West  Indies,  this  consti- 
tuted them  the  '^fons  et  origo'^  as  they  continue 
to  be  till  this  day,  the  fountain  head  of  yellow 
fever;  though  as  the  early  writers  attributed  the 
first  epidemics  to  the  arrival  of  slave  ships,  they 
thought  its  origin  must  be  in  the  East.  But 
of  all  our  yellowed  spots  showing  where  the 
disease  has  prevailed  at  some  time  in  the  past, 
there  is,  not  one  spot  of  land  among  them  shown 
to   be  its  birth-place  or  original  home. 

Now  Dr.  Audouard's  discovery  was  that  the 
terrible  epidemic  at  Barcelona  in  1821,  in  which 
five  thousand  persons  died,  was  caused  by  the 
arrival  of  two  old  slave  ships,  the  Grand  Turc 
and  the  St.  Joseph,  with  a  cargo  of  West  India 
produce;  and  they  were  found  to  be  so  foul  and 
filthy  that  they  had  to  be  scuttled.  At  Passages 
in  1823  he  found  an  innocent  looking  brigantine, 
the  Dionostiarra,  which  had  brought  a  cargo 
from  Havana  and  was  then  having  her  hull  re- 
paired. The  first  cases  of  yellow  fever  occurred 
among  the  carpenters  engaged  in  these  repairs, 
and  they  attributed  their  illness  to  a  foul,  sick- 
ening smell  issuing  from  the  hold  and  bilges  of 


YELLOW   FEVER.  29 

the  vessel.  From  these  cases  an  epidemic  fol- 
lowed; and  inquiry  into  the  vessel's  history  re- 
vealed that  she  was  then  engaged  in  the  contra- 
band slave  trade  and  was  completing  her  round 
voyage,  having  taken  negroes  from  Africa  to  the 
West  Indies  and-  broiiglit  back  a  cargo  of  the 
products  of" those  islands.  Dr.  Audouard,  find- 
ing that  there  were,  sixty"  or  seventy  ships  en- 
gaged in  this  traffic  making  these  round  voyages, 
argued  that  the  same  circumstances  that  he 
found  at  Barcelona  and  Passages  must  have  oc- 
curred repeatedly  at  the  various  other  Spanish 
ports  where  yellow  fever  had  been  epidemic  time 
and  again.  The  historical  fact  that  when  these 
vessels  ceased  to  arrive  at  those  ports  yellow 
fever  also  ceased  to  prevail  and  disappeared 
from  the  coast  of  Spain  to  return  no  more,  is 
strongly  corroborative  negative  evidence  of  the 
truth  of  his  argument. 

The  theory  deduced  by  Dr.  Audouard  from 
the  occurrences  at  Barcelona  and  Passages  was 
that  the  specific  infection  which  caused  yellow 
fever  issued  from  the  hold  of  the  slave  ships, 
having  been  generated  by  the  fermentation  and 
putrefaction  of  the  dysenteric  discharges  and 
other  filth  accumulating  from  the  negroes 
during  the  voyage  over  from  Africa.  So  great 
was  this  accumulation  that  the  cleansing  of  a 
slaver  was  said  to  be  a  Herculean  task  indeed 
at  which  white  men  could  not  work,  and  the  ne- 
groes were  thus  forced  to  do  it.     This  was  where 


30  YELLOW   FEVER. 

the  traffic  was  carried  on  under  government  in- 
spection and  larger  and  better  ventilated  ves- 
sels were  used.  But  the  contraband  ships  were 
small,  ill-ventilated,  over-crowded  and  never 
properly  cleaned  or  disinfected;  so  that  it  can 
be  readily  perceived  that  they  carried  within 
their  walls  enormous  quantities  of  that  peculiar 
filth  necessary  for  the  development  of  the  germ 
principle  of  the  disease,  and  that  thus  they  be- 
came mediums  for  the  transmission  of  the 
materies.mo7'bt  of  yellow  fever  back  and  forth 
over  the  Atlantic  and  were  a  menace  and  source 
of  danger  wherever  they  cast  anchor,  even  though 
they  came  with  clean  bills  of  health  and  no  cases 
of  the  disease  had  occurred  during  the  voyage. 
Audouard  and  other  writers  upon  this  point 
seemed  to  think  it  was  necessary  for  this  filth  to 
be  thrown  overboard  and  mixed  with  the  mud 
and  filth  of  the  seaboard  cities  in  order  for  it  to 
produce  yellow  fever;  but  there  is  no  reason 
why  under  suitable  meteorological  conditions  it 
should  not  develop  on  board  and  become  the 
fever  of  the  voyage.  This  is  why  I  said  it  was 
born  upon  the  high  seas;  and  taking  into  con- 
sideration all  the  facts  and  conditions  connected 
with  its  production  and  comparing  them  with  a 
few  well  authenticated  and  similar  cases,  we  are 
fully  justified  in  concluding  that  the  first  cases 
of  yellow  fever  with  which  our  race  was  afflicted 
originated  on  board  slave  ships  during  the  voy- 
age from  Africa  through  the  '^Middle  Passage;" 


YELLOW   FEVER.  31 

and  this  is  the  only  rational  explanation  of  the 
enormous  mortality  among  the  white  crews  of 
these  ships. 

That  this  excessive  mortality  did  occur  was 
learned  only  by  Clarkson's  persistent  inquiry 
and  investigation  of  the  matter;  for  the  knowl- 
edge of  it  was  suppressed  by  the  owners  of  the 
vessels,  as  they  feared  that  if  it  were_  generally 
known  it  would  prevent  their  obtaining  a  suffi- 
cient number  of  recruits  to  properly  man  and  run 
the  ship.  This  was  an  example  of  the  suppres- 
sion of  truth  for  mercenary  and  pecuniary  rea- 
sons. While  Audouard's  theory  was  suppressed 
at  first  for  political  reasons,  it  was  afterwards 
suppressed  or  rejected  by  the  physicians  of  the 
United  States,  especially  those  of  the  South, 
through  bigotry  caused  by  the  passions  and 
predjudices  arising  out  of  the  institution  of 
slavery.  That  institution  was  maintained  and 
guarded  with  so  much  jealousy,  and  our  minds 
were  so  deeply  imbued  with  the  theory  of  the 
local  origin  of  yellow  fever  as  taught  by  the 
great  Doctors  Rush  and  Physick,  that  we  had  no 
patience  to  entertain  or  investigate  any  theories 
which  reflected  upon  or  conflicted  with  that  in- 
stitution. Born  and  reared  upon  a  slave  plan- 
tation, as  were  my  father  and  grandfather  before 
me,  and  familiar  with  all  the  workings  of  an  in- 
stitution which  was  so  lon^  a  curse  and  incubus 
upon  our  fair  land,  I  feel  privileged  to  speak 
thus  of  fhe  institution  and  its  evil  results. 


32  YELLOW  FEVER. 

To  my  mind  there  is  no  one  single  etiological 
or  pathological  fact  in  the  domain  of  medicine 
that  rests  upon  so  sure  and  clear  a  basis  for  its 
truth  as  the  fact  that  this  far-reaching  Nemesis, 
yellow  fever,  was  the  product  solely  of  the  ne- 
farious slave  traffic.  This  can  be  demonstrated 
beyond  the  power  of  refutation,  and  clearly  con- 
stituted it  an  artificial  disease  resulting  from 
man's  violation  of  natural  law;  hence  it  should 
be  and  is  in  the  power  of  man  to  exterminate  it. 
I  claim  that  it  has  been  driven  to  and  is  now  oc- 
cupying, the  last  ditch,  not  by  man's  efforts,  it 
is  true,  but  by  the  forces  of  nature:  working  un- 
der favorable  conditions.  In  this  last  ditch  of 
defense,  or  rather  of  existence,  but  little  of  man's 
labor  would  be  required  to  aid  the  same  forces  to 
silently  but  effectually  sweep  the  last  vestige  of 
this  scourge  from  the  earth. 

Look  again  at  our  yellow-spotted  map  of 
the  world  and  with  unprejudiced  mind  trace 
the  traffic  and  mark  the  ports  of  most  frequent 
debarkation  during  the  periodwhenit  was  recog- 
nized as  a  legitimate  trade  and  see  its  constant 
and  intimate  association  with  yellow  fever  from 
1693  down  to  1808.  Read  the  history  of  its  fre- 
quent and  destructive  ravages  in  the  most  im- 
portant of  those  northern  ports,  Boston,  New 
York  and  Philadelphia;  then  mark  its  sudden 
and  complete  disappearance  upon  the  abolition 
of  the  traffic  by  England  and  the  United  States 
in  1808.     Observe  how  closely   it   accompanied 


YELLOW  FEVER.  33 

the  contraband  trade  to  the  West  Indies,  where 
its  most  destructive  epidemics  occurred  during 
the  most  prosperous  period  of  the  illegal  traffic; 
and  how  when  this  was  suppressed  by  English 
and  American  cruisers  it  was  diverted  to  South 
America;  and  how,  as  the  slave  trade  of  Brazil 
enormously  increased,  yellow  fever  again  made 
its  appearance  in  Rio  Janerio  for  the  first  time 
in  a  century  and  a  half. 

As  stated  before,  the  terrible  epidemics  that 
ravaged  the  coast  of  Spain  during  the  first  quar- 
ter of  this  century  were  shown  by  Audouard  to 
have  been  caused  by  the  specific  infection  issu- 
ing from  the  hold  of  one  or  more  of  those  con- 
traband ships  which  had  arrived,  shortly  before 
the  epidemic  began,  with  a  cargo  of  West  Indian 
products  on  the  return  voyage  from  having  car- 
ried a  cargo  of  negroes  from  Africa  to^  those 
islands.  Audouard  in  his  investigation  of  the 
epidemic  at  Passages  in  1823  found  that  the 
Donostiarra,  a  slaver,  had  arrived  from  Havana 
with  a  clean  bill  of  health  and  that  there  had 
been.no  case  of  yellow  fever  aboard  during  the 
voyage,  neither  had  there  been  any  in  the  port 
prior  to  her  arrival.  Her  cargo  being  disposed 
of  and  her  hull  needing  repairs,  -the  carpenters 
of  Passage  were  employed  to  do  the  work;  but 
as  soon  as  the  first  plank  was  ripped  from  her 
bottom  the  workmen  one  after  another  began  to 
fall  ill  of  yellow  fever,  and  they  rightly  attrib- 
uted their  illness  to  a  sickening  smell  that  came 


34  YELLOW  FEVER. 

from  the  foul  bilges  of  the  vessel  as  they  opened 
them  up.  Will  any  unpredjudiced  person  de- 
mand clearer  proof  of  the  relation  of  cause  and 
effect  as  presented  in  the  history  of  this  case  (and 
it  is  not  a  solitary  case  either),  or  will  any  one 
be  so  unreasonable  as  to  require  further  evidence 
of  the  relationship  between  the  slave  traffic  and 
yellow  fever  than  I  have  adduced  in  the  preced- 
ing pages  wherein  I  have  shown  by  incontro- 
vertible historical  facts  that  a  most  intimate, 
constant,  close  and  unbroken  connection  and 
association  existed  between  the  two,  both  in 
time  and  place,  from  their  earliest  history  down 
to  the  time  when,  the  traffic  being  suppressed,- 
the  cause  ceased  to  exist. 

Is  it  then  unreasonable  to  hope,  yea,  to  expect 
and  believe  that  in  time  the  effect,  too,  may  be 
eradicated?  This  has  already  transpired  at 
various  times  and  places.  Just  prior  to  the  war 
of  American  Independence  the  slave  trade  was 
at  its  height.  England  alone  had  one  hundred 
and  ninety-two  ships  engaged  in  the  traffic,  with 
space  for  transporting  47,146  negroes  (Encyclo- 
pedia Britannica — "Slavery.")  with  which  she 
was  supplying  her  North  American  colonies  that 
she  was  so  soon  to  lose.  Thus  during  the  le- 
gitimate traffic  these  vessels,  with  many  of 
other  nations,  entered  our  northern  ports  hun- 
dreds of  times  annually;  and  the  peculiar  filth 
which  gave  rise  to  the  specific  infection  of  yel- 
low fever  was  pumoed  up  and  thrown  overboard 


YELLOW  FEVER.  35 

from  their  holds  in  material  quantities  to  mix 
and  mingle  with  the  mud  of  their  harbors  and  to 
penetrate  the  soil  under  the  wharves  and  low- 
lying  quarters  of  the  towns  where,  under  the 
heat  of  a  summer's  sun,  it  fermented  and  gener- 
ated that  specific  poison,  thus  enabling  the 
disease  to  become  and  remain  indigenous  so 
long  as  the  yearly  accretions  of  that  peculiar 
filth  continued;  and  this  afforded  a  rational 
basis  for  the  opinions  enunciated  in  1798  by 
Doctors  Rush,  Physick  and  others  of  the  Phila- 
delphia Academy  of  Medicine  that  the  disease 
was  a  native  of  our  country.  But  see  how  soon 
after  the  suppression  of  this  traffic  the  scourge 
ceased  to  occur  in  those  same  ports  where  for'a 
century  it  had  prevailed  so  frequently  and  viru- 
lently. 

Water,  one  of  nature's  most  useful  and 
powerful  forces,  in  the  shape  of  the  turbu- 
lenti  tossing,  pitching  waves  and  tides  of 
the  Atlantic  Ocean  was  the  means  by  which 
those  polluted  harbors  were  cleansed,  the  local- 
ities being  favorably  situated  for  the  accomplish- 
ment of  this  purifying  process  without  man's 
aid.  All  cause  of  the  local  origin  of  the  disease 
thus  having  been  removed  the  rigid  enforcement 
of  a  perfected  quarantine  system  has  since  pre- 
served  them,  with  one  or  two  exceptions,  from 
any  more  of  its  ravages.  This  is  only  one  ex- 
ample of  the  many  furnishing  incontestable  evi- 
dence of  the  exotic  nature  of  the  maieries  morbi 


36  YELLt)W   FEVER. 

of  this  specific  disease  and  of  the  intrinsic  value 
of  quarantine  in  preserving  a  country  from  its 
invasions. 

Yellow  fever  prevailed  at  Rio  Janerio  for  a 
number  or  years  during  the  latter  part  of  the 
iVth  century,  but  disappeared,  when  the  slave 
trade  was  diverted  to  the  North  American  Con- 
tinent, and  was  unknown  there  for  a  century  and 
a  half;  but  when  the  contraband  ships,  seeking 
a  market  for  their  cargoes,  after  being  driven 
from  the  ports  of  nearly  all  other  countries,  be- 
gan to  arrive  there  in  1849,  yellow  fever  also 
accompanied  them  and  established  itself  as  a 
disease  new  to  the  country,  prevailing  with  un- 
exampled virulence.  It  has  remained  there  ever 
since  and  is  said  to  have  become  indigenous. 

Personally  I  know  nothing  of  the  topography 
of  Rio  or  other  Brazilian  ports;  yet  it  is  fair  to 
presume  that  having  disappeared  once,  naturally, 
it  may  do  so  again  or  be  made  to  do  so  by  the 
intelligent  efforts  of  man.  But  the  great 
source  of  danger  to  our  country  is  not  the  ports 
of  Brazil  nor  the  Island  of  Cuba  itself  nor  the 
city  of  Havana  in  particular,  but  the  putrid 
water  of  the  bay  of  Havana — an  almost  tideless, 
stagnant  pond  dotted  with  mud-banks  or  shoals 
and  surrounded  by  high  hills  with  but  a  single 
narrow  opening  to  the  Gulf,  so  that  its  waters 
cannot  be  changed.  It  has  so  long  been  offen- 
sive and  full  of  decomposing  organic  matter  that 
as  far  back  as  1821  there  was   a   standing   order 


hi^  '57  •^-- 


YELLOW   FEVER.  37 

in  the  the  British  naval  service  not  to  use  the 
water  for  any  purpose.  Doubtless  -the  first  poor 
negroes  and  slaves  in  the  Western  Hemisphere 
came  in  a  Spanish  galleon  into  that  then  un- 
polluted-bay; for  it  is  said  that  a  few  were 
brought  over  even  during  the  time. of  Columbus, 
and  that  he  recommended  the  exchange  of  In- 
dian prisoners  for  Africans.  Be  that  as  it  may, 
Havana  was  headquarters  for  the  slave  traffic 
from  its  beginning  until  -its  cessation;  and  for 
three  centuries  hundreds  of  slavers  annually 
cast  anchor  in  the  bay,  scoured  and  threw  over- 
board the  filth  of  their  holds  and  pumped  the 
putrid  water  of  their-  bilges  into  it.  So  great 
was  the  quantity  of  this  peculiar  filth  thus  added 
to  these  quiet  waters  at  times  that  it  penetrated 
and  became  a  part  of  the  mud-banks,  perme- 
ating even  the  soil  of  the  shores,  of  the  wharves 
a^d  of  the  low-lying  quarters  of  the  town,  viti- 
ating and  polluting  the  sea  water  to  the  extent 
of  rendering  it  temporarily  destructive  to  the 
fish.  - 

I  mentioned  that  Dr.  Audouard  found  that  the 
Donosfiarra,  to  which  he  traced  the  origin  of 
the  epidemic  of  yellow  fever  at  Passages  in  1823, 
had  arrived  from  Havana  with  a  clean  bill  of 
health  and  had  had  no  cases  of  the  disease  oh 
board  during  the  voyage.  Innumerable  instances 
of  the  same  kind  are  on  record  of  vessels  having 
left  Havana  with  clean  bills  of  health,  not  a 
single  case  of  yellow  fever  existing  in  the  city  at 


38  YELLOW   FEVER. 

the  time  of  their  sailing;  yet  they  proved  to  be 
sources  of  danger  and  infection  to  other  places 
which  they  visited  months  afterwards  because 
they  took  with  them  in  their  holds  and  bilges  a 
sufficient  quantity  of  the  necessary  filth,  obtained 
from  the  water  of  the  bay,  to  generate  the  spe- 
cific infection.  A  great  deal  has  been  said  and 
written  about  these  Cuban  * 'clean  bills  of 
health,"  and  Dr.  S.  E.  Chaill^,  President  of  the 
United  States  Havana  Yellow  Fever  Commission, 
in  1879,  writes  in  his  report:  **Tp  the  sani-' 
tarian  it  is  a  deplorable  farce  that  commerce 
should  be  burdened  with  such  bills  of  health  as 
the  Cuban  authorities  at  Havana  issued  after 
October  4,  1879."  But  if  Professor  Chaill^  and 
the  Cuban  authorities  had  understood  clearly 
the  true  status  of  the  case  and  known  where  the 
real  danger  lay,  he  would  not  have  had  occasion 
thus  to  characterize  them  for  they  would  npt 
have  been  issued  if  the  authorities  had  been 
honest.  This,  however,  the  professor  questions 
in  no  doubtful  language;  but  let  us  leave  the  dis- 
cussion of  this  point  to  future  revelations  upon 
the  subject. 

The  great  difficulty  and  hindrance  to  the  ac- 
quisition of  a  correct  knowledge  of  this  unique 
disease,  from  the  days  of  Rush  down,  has  been 
too  much  egotism  and  too  great  confidence  in 
the  mind  of  each  observer  and  investigator  that 
he  alone  was  right  and  everyone  else  wrong  in 
regard  to  the  respective  theories  and   ideas   ad- 


YELLOW  FEVER.  39 

vanced.  This  most  singular  of  all  peculiar 
diseases  produces  very  strange  but  varying  im- 
pressions upon  the  minds  of  persons  in  the  dif- 
ferent walks  of  life  who  have  been  so  fortunate 
as  to  recover  from  an  attack.  Dr.  LeMonnier 
in  an  article  upon  the  subject  written  after  the 
epidemic  of  IS^S  says:  ''The  more  we  physi- 
cians see  of  thedisease  the  more  we  desire  to  see 
of  it  and  the  greater  we  discover  our  ignorance 
to  be;"  and  Chopin,  of  New  Orleans,  whose  op- 
portunities for  investigation  and  observation 
during  the  epidemic  of  1878  were  unequalled, 
writes:  "We  really  know  nothing  about  yellow 
fever."  But  the  most  singular  effect  of  all  is 
that  which  it  produces  upon  the  minds  of  non_ 
professionals.  I  do  not  think  I  exaggerate  miich 
in  saying  that  nine  hundred  and  ninety-nine  in 
every  thousand  who  pass  through  the  disease 
successfully  get  up  deeply  imbued  with  the  idea 
that  they  possess  all  knowledge  of  the  disease; 
and  in  succeeding  epidemics  many  of  them  pre- 
sent themselves  as  superior  not  only  to  all  skil- 
fully trained  yellow-fever  nurses  but  to  the 
whole  medical  profession  in  their  ability  to  care 
for  and  treat  patients;  and  in  addition  some 
write  learned  (?)  essays  for  the  newspapers  on 
the  origin,  nature,  treatment,  etc.,  of  yellow 
fever.  It  is  possible  that  the  medical  profession 
is  responsible  for  this  because  of  their  proneness 
to  over-medication,  especially  in  a  disease  like 
yellow   fever   of   the   nature   of   which   we   are 


40  YELLOW   FEVER. 

totally  ignorant  and  for  which  no  antidote  or 
positive  cure  has  been  discovered.  That  Chopin 
was  practically  right  in  18 78  and  that  we  have 
made  no  material  advance  in  our  knowledge  of 
this  disease  since  the  days  of  Rush,  was  clearly 
demonstrated  during  the  late   epidemic   of   so-  j 

called  yellow  fever  which  prevailed  so  exten- 
sively throughout  the  entire  Southwest  during  } 
the  months  of  September,  October  and  Novem-  | 
ber,  1897.                                                                                    I 

If  it  were  not  the  fact  that  but  few  physicians  j 

of  the  present  generation  have  ever  seen  a  case  | 

of  yellow  fever  and  that  its  visits  to  this  country  I 

fortunately  are  becoming  fewer  and  farther  be- 
tween, it  would  seem  passing  strange  that  the 
profession  are  still  wholly  unable   to   recognize  j 

this  unique  disease  which  is,so  strongly  individ-  j 

ual  in  its  characteristics  and  whose  facies  are  so 
remarkable  that  they  should  not  be  confounded 
with  those  of  any  other  malady.  But  I  am 
wandering  from  the  real  subject  of  this  section  "  .  - 
which  I  will  close  by  endeavoring  to  recapitulate 
the  main  points  that  I  have  presented. 

I  believe  that  I  have  established  as  a  fact 
beyond  the  possibility  of  refutation  that  there 
has  always  been  such  a  close  and  continuous 
connection  between  the  old  African  slave  trade 
and  yellow  fever  as  to  clearty  put  •  them  in  the 
relation  of  cause  and  effect.  This  being  ac- 
cepted as  a  truth  places  yellow  fever  in  a  cate- 
gory by  itself  as  a  purely  artificial  disease,  that 


YELLOW   FEVER.     '  41 

is,  one  caused  solely  by  acts  of  man;  hence  it  is 
possible  to  exterminate  and  eradicate  it  from  the 
globe.  The  history  of  the  cause,  th^  slave 
traffic  has  been  closed  forever;  while  the  con- 
tinuous history  of  the  effect,  yellow^  fever,  dem- 
onstrates the  plausibility  and  great  probability 
of  the  fulfillment  of  my  prediction.  It"  needs 
but  a  glance  at  our  yellow-dotted  map  to  show 
that,  since  the  complete  suppression  of  the 
trafiic,  yellow  fever  has  entirely  disappeared 
from  the  ports  of  Spain  and  all  other  places  on 
the  Eastern  Hemisphere  where  it  had  prevailed 
during  the  existence  of  the  slave  ships.  So  also 
it  has  ceased  to  appear  at  theports  of  our  Atlantic 
seaboard;  and  it  is  only  occasionally  now  that 
it  slips  into  a  few  of  our  gulf  ports  owing  to 
their  contiguity,  to  its  last  .stronghold,  Havana, 
which  has  so  long  and  so  generally,  though 
erroneously,  been  supposed  to  be  its  original 
home.  _ 

I  have  not  been  able  to  find  an  author  who' 
could  ascribe  its  origin  positively  to'  any 
country.  The  United  States  and  Mexico  ascribe 
its  origin  to  importation  from  Havana,  while 
Havana  and  Brazil  attribute  it  to  Spain  who  in 
turn  haughtily  rejects  it  and  refers  the  origin 
back  to  the  West  Indies,  or  to  Asia  and  Africa; 
but  these  countries  indignantly  deny  the  charge 
and  say  that  they  never  gave  it  to  Europe,  but 
always  received  it  from  her.  So  as  no  land  has 
been  found  that  will  acknowledge  the  paternity 


42  YELLOW   FEVER. 

of  this  nomadic  Nemesis  or  accept  it  as  a 
legitimate  offspring,  I  claim  my  location  of 
its  origin  to  be  the  true  one — born  upon  the 
high  seas  as  a  specific  infection  generated  from 
peculiar  filth  found  in  the  holds  of  African  slave 
ships,  these  vessels  being  the  medium  by  which 
this  poison  was  transported  to  and  distributed 
among  the  various  ports  to  which  their  nefarious 
traffic  directed  them.  I  find  as  valuable  a  testi- 
mony to  sustain  my  position  as  I  could  ask, 
given,  though  unwittingly,  by  Prof.  S.  E. 
Chains  in  1874.  In  his  paper  on  ''Vital  Statis- 
tics of  New  Orleans  from  1769  to  1874"  he 
closes  the  paragraph  on  yellow  fever,  while  yet 
arguing  against  the  value  of  quarantine  and  in 
favor  of  the  local  origin  of  the  disease,  with  the 
following:  ''The  experience  of  the  United 
States  river  fleet  at  New  Orleans  in  1863-64  con- 
firms many  other  indications  that  yellow  fever  is 
especially  prone  to  originate  in  the  holds  of 
vessels." 

Now  Assistant  Surgeon  Harvey  E.  Brown  of 
the  United  States  Army,  in  his  report  on 
"Quarantine  on  the  Southern  and  Gulf  Coasts,^" 
referring  to  this  same  "river  fleet"  of  1863-64, 
says:  "The  vessel  on  which  the  yellow  fever 
originated,  the  Virginia  I  believe,  had  been  an 
old  slaver  but  was  captured  in  the  early  part  of 
the  war  and  turned  into  a  gunboat."  What 
more  direct  and  positive  evidence  of  the  truth 
of  this  proposition  could  be  desired?     While  it 


YELLOW   FEVER.  43 

was  a  strange  admission  for  one  to  make  who 
was  even  then  teaching  the  local  origin  of .  the 
disease,  yet  it  is  not  a  solitary  case;  for  from  the 
days  of  Rush  down  to  the  present  I  find  the 
.most  ardent  and  zealous  of  the  medical  writers 
who  taught  this  theory  qualifying  their  opinions 
and  reports  by  admitting  that  the  arrival  of 
vessels  from  the  West  Indies  or  other  known 
foci  of  infection  frequently  caused  a  rapid  in- 
crease of  the  fever,  owing  to  the  foul  air  and 
offensive  odors  which  issued  from  their  filthy 
holds  and  reeking  bilges. 

Surely  they  do  not  mean  by  these  admissions 
to  claim  that  the  holds  of  those  nomadic  buc- 
caneers were  a  part  and  parcel  of  the  port  in 
whose  harbor  they  temporarily  cast  anchor;  for 
it  was  only  in  the  holds  of  vessels  of  this  class, 
slavers,  that  the  specific  poison  has  ever  heen 
known  to  be  generated,  with  the  notable  excep- 
tion of  a  few  transports  carrying  negroes  and 
Chinese  coolies  and  of  certain  wooden  ships  lying 
up  in  West  Indian  ports.  I  will  now  give,  an 
account  of  these,  quoting  from*  the  writings  of 
Dr.  C.  Creighton  to  whom  I  am  much  indebted 
for  many  of  my  foregoing  thoughts  and  also  for 
recalling  Dr.  Audouard's  theory  to  my  attention, 
which  I  had  rejected  and  refused  to  properly 
investigate  forty  odd  years  ago. 

* 'The  Regalia,  a  British  transport,  was  em- 
ployed in  1815  to  carry  black  recruits  from  the 
coast  of  Guinea  to  the  West  Indies.     When  on 


44  YELLOW   FEVER. 

the  coast  the  health  on  the  ship  had  been  excel- 
lent, but  during  the  voyage  much  sickness, 
chiefly  of  the  dysenteric  kind,  occurred  among 
the  blacks.  Thereupon  yellow  fever  broke  out 
with  great  malignancy,  attacking  all  on  board 
except  the  blacks  who  from  first  to  last  were 
exempt."  The  case  of  the  Regalia  is  weil 
known  and  it  used  to  be  quoted  as  showing  that 
yellow  fever  was  only  a  form  of  malarial  fever, 
the  malarial  miasm  in  this  case  having  come 
from  a  quantity  of  green  wood  that  had  been 
shipped  at  Boa  Vista.  The  green-wood  theory 
was  always,  improbable,  and  the  modern  dis- 
entanglement of  yellow  fever  from  malarial 
remittents  deprives  it* of  whatever  small  prob- 
ability it  ever  had.  The  other  case  which  I 
take  from  Gillespie  is  equally  suggestive.  The 
French  frigate,  La  Pique,  fell  into  the  hands  of 
the  English  when  Martinique  was  taken  in 
1'794,  and  in  November  1*795  was  sent  with  a 
prize  crew  to  the  Barbadoes.  On  the  voyage  they 
took  two  hundred  negroes  from  a  French  vessel 
that  was  in  danger  of  foundering.  The  negroes 
were  confined  in  the  hold  and  in  a  short  time 
yellow  fever  appeared  among  the  La  Pique's 
crew  and  proved  fatal  to  one  hundred  and  fifty 
of  them,  although  it  did  not  attack  the  negroes 
at  all.  ''Such  a  mixture  of  men,  strangers  to 
each  other,"  says  Gillespie,  "has  often  been 
found  to  occasion  sickness  in  ships;  and  together 
with   other  causes    operated  fatally  before  the 


YELLOW   FEVER.  45 

arrival  of  the  ship  at  the  Barbadoes.  *  *  *  This 
is  a  melancholy  instance  of  the  generation  of  a 
fatal  epidemic  on  ship  board  at  a  time  when,  the 
inhabitants  of  the  Barbadoes  and  the  crews  of  the 
other  ships  in  company  with  the  La  Pique  re- 
mained free  from  any  such  disease." 

It  will  readily  be  seen  that  Audouard's  theory 
of  the  immunity  of  the  pure-blooded  negro  from 
yellow  fever  is  perfectly  sustained  in  both  these 
instances.  As  still  further  testimony-  of  its 
truth,  Dr.  Creighton,  referring  to  the  French 
expedition  to  Mexico,  and  says;  "The  Nubian 
regiment  of  five  hundred  blacks,  recruited  by 
the  French  in  the  Soudan  and  Nubia  for  this 
expedition,  did  not  lose  a  single  man  nor  even 
have  a  single  case  of  yellow  fever  in  the  epi- 
demic at  Vera  Cruz  in  1866,  while  the  French 
soldiers  were  dying  by  the  hundreds."  He  also 
cites  the  circumstance  of  the  production  of 
yellow  fever  on  the  coast  of  Peru,  in  1853,  by 
the  importation  of  Chinese  coolies,  and  says: 
* 'Although  apparently  in  contradiction  these 
facts  are  really  corroborative,  for  the  Chinese 
themselves  were  as  exempt  from  the  disease 
there  and  then  as  were  the  negroes  on  the  oppo- 
site side  of  the  continent,  having  been  brought 
there  under  the  same  conditions." 
-  Of  wooden  ships  -Dr.  Creighton  says:  ^'I 
shall  mention  briefly  the  most  terrible  historical 
instance  of  ships  charging  themselves  with  the 
poisonous  mud  of  a  slave  port.     On  the  capture 


46  YELLOW   FEVER. 

of  Port  au  Prince,  Hayti,  June  4th,  1794,  about 
forty  merchantmen  were  found  in  the  harbor, 
most  of  them  large  vessels  laden  with  cargoes 
of  coffee,  sugar,  cotton  and  indigo  which  had 
been  lying  stored  in  them  from  one  to  three  years. 
Owing  to  the  suspension  of  business  during  the 
Revolution  many  of  them  had  never  had  their 
holds  open  all  that  time.  English  prize- 
crews  were  put  on  board  to  navigate  them 
to  Port  Royal  and  other  British  West  Indian 
ports,  and  they  had  hardly  put  to  sea  when 
yellow  fever  attacked  them  with  unheard-of  sud- 
denness and  virulence.  One  of  the  prizes  was 
picked  up  by  a  Guineaman  and  everyone  on 
board  was  found  to  be  dead.  Even  the  negroes 
who  were  put  to  cleaning  them  out  took  the  fever 
and  died." 

I  will  now  go  back  to  the  fierce  controversial- 
ists in  the  last  decade  of  the  eighteenth  century 
at  Philadelphia,  for  I  promised  to  explain  my 
paradoxical  remark  that  both  parties  were  right 
in  those  angry  controversies.  I  verily  believe 
that  if  those  intellectual  giants  in  medicine.  Doc- 
tors Rush,  Hutchison,  Physic  and  others  of  the 
Academy  of  Medicine  on  the  one  side,  with  Doc- 
tors Curry,  Carpenter,  Chapman  and  others  of  the 
College  of  Physicians  on  the  other,  could  revisit 
the  scenes  of  their  labors  and  see  the  present 
status  of  the  two,  which  I  call  cause  and  effect, 
/'.  e.j  the  slave  traffic  and  yellow  fever,  they 
would    all    be  enabled   easily   to   see  not   only 


YELLOW  FEVER.  47 

wherein  they  were  right,  but  also  wherein  they 
were  wrong  and  would  grandly  confess  their 
errors,  unitedly  agreeing  that  my  deductions- 
are  rational  and  that  they  are  sustained  by  all 
the  facts  in  the  subsequent  history  of  the  disease. 

First.  I  have  shown  that  from  the  time  of  the 
arrival  of  the  Dutch  ship  with  a  few  Africans  on 
the  Virginia  coast  in  1620,  down  to  1776,  pos- 
sibly to  1793,  the  peculiar  filth  to  which  the  dis- 
ease owes  its  origin  had  been  gradually  deposited 
in  various  harbors  of  our  Atlantic  coast,  especial- 
ly irr  the  mud  of  the  Delaware  at  Philadelphia, 
till  a  sufficient  quantity  had  -accumulated  to  ren- 
der the  disease  temporarily  indigenous,  sustain- 
ing Doctors  Rush  and  his  party  in  claiming  that 
it  did  originate  there  after  1793.  But,  as  I  have 
said  before,  I  find  that  they  nearly  always  quali- 
fied their  reports  by  referring  to  fresh  arrivals 
of  infected  vessels  as  adding  greatly  to  the  fury 
of  the  disease. 

Second.  The  importationists,  Curry  and 
■his  followers,  were  right.  This  party  is  al-^ 
ways  right  everywhere,  for  if  my  location  of 
the  birthplace  of  the  scourge  is  correct,  that  it 
originated  de  novo  on  the  high  seas,  it  necessarily 
follows  that  it  was  originally  an  exotic  to  all 
countries  and  had  to  be  imported.  But  at 
Philadelphia  this  party  erred  in  denying  that  it 
ever  originated  at  all,  although  tHey  could  hardly 
be  blamed,  for  it  was  never,  defacio,  a  native 
there,    as   the  material  for   its   generation  was 


48  -  .      YELLOW  FEVER. 

brought  in  the  bottoms  of  transient  rovers  of  the 
seas  and  deposited  there. 

Third.  They  would  readily  see  that  the  dis- 
ease has  entirely  disappeared  since  the  suppres- 
sion of  the  slave  traffic,  and  that  the  waters  of 
the  Atlantic,  unaided,  had  long  since  removed  all 
traces  of  its  peculiar  filth  from  every  port  on 
that  coast  where  it  had  so  frequently  prevailed 
in  their  day,  from  Portsmouth,  N.  H.,  on  the 
north  to  the  cape  of  Florida  on  the  south,  and 
that  a  rigid  quarantine  had  barred  its  entrance. 
Yellow  fever  has  since  also  disappeared  from 
our  gulf  ports  as  well,  New  Orleans  prob- 
ably being  the  last  point  to  yield  because  of 
later  additions  to  the  filth  at  that  point;  but 
the  immense  volume  of  water  annually  poured 
down  the  mighty  Father  of  Waters  has  finally 
been  victorious  and  swept  the  last  vestige  of  it 
into  the  sea,  so  that  it  cannot  be  truthfully 
claimed  to  be  indigenous  to  any  part  of  the 
United  States. 

Fourth.  They  would  also  see  that  it  has 
ceased  in  all  places  in  Europe  and  Africa  where 
it  prevailed  almost  constantly  during  the  exist- 
ence of  the  slave  traffic,  as  well  as  in  all  the 
ports  of  that  hot-bed,  the  West  Indies,  except- 
ing the  foul  bay  of  Havana;  and  they  would  not 
say,  after  a  glance  over  our  yellow-dotted  map, 
that  I  am  using  a  fanciful  or  extravagant  ex- 
pression in  saying  that  it  now  occupies  the  last 
ditch,   in  a  forlorn  hope  of  continued  existence 


^^ 


■^  YELLOW  FEVER.  49 

from  whence  it  occasionally  does  send  out  de- 
tachments of  germs  of  the  specific  infection  in 
fomites  of  various  kinds  in  filthy  vessels  to 
ravage  certain  localities,  but  that  it  cannot  and 
never  will  again  pollute -another  harbor  of  the 
world  sufficiently  to  enable  it  to  become  an 
indigene  in  that  country. 

That  "ditch"  can  easily"  be  cleaned  by  intel- 
ligent efforts  directed  to  aiding  Nature's  great 
minister  of  cleanliness,  water,  to  properly  per- 
form its  task  of  ablution,  by  digging  two  or 
more  canals  from  different  points  on  the  coast 
(even  across  the  island  if  necessary,  for  expense 
should  not  be  counted  in  such  an  enterprise) 
opening  into  that  sluggish  bay,  in  order"  to 
create  currents  sufficient  to  completely  change 
the  water  and  carry  out  all  the  fermenting  and 
piitrifying  organic  matter  contained  therein. 
Then  should  follow  proper  cleaning  and  scien- 
tific disinfection  of  the  mud  of  the  shores  and 
low-lying  parts  of  the  town,  until  every 
trace  of  the  poisoti  be  eradicated;  and  at  the 
same  time  all  negroes  should  be  removed  from 
these  localities. 

I  know  this  will  never  be  done  by  the  present 
owners  of  the  Island;  but  it  can  and  should  be 
done  for  the  good  of  humanity.  Two  powerful 
and  highly  civilized  nations  like  England  and 
the  United  States,  by  assuming  a  protectorate 
over  Cuba  for  Spain,"  (I  doubt  if  the  present 
population  is  worthy  or  capable  of  self-govern- 


50  YELLOW   FEVER. 

ment)  could  easily  accomplish  this  and  at  the 
same  time  put  a  stop  to  the  inhuman  butchery 
now  going  on  (the  winter  of  '97-98),  which  is  a 
disgrace  to  the  nineteenth  century. 

Let  all  harbor  revenues  above  the  expenses  of 
the  protectorate  be  applied  to  this  one  object  and 
it  would  soon  be  accomplished.  Then  the  work 
of  this  Nemesis  will  end,  its  mission  of  venge- 
ance having  been  accomplished,  and  yellow 
fever  will  become  as  truly  a  thing  of  the  past  as 
has  its  cause,  the  slave  traffic;  while  at  the  same 
time  the  value  of  Cuba  will  have  been  enhanced 
an  hundred-fold. 

One  thought  more.  I  have  stated  the  error 
of  the  importationists;  that  of  che  other  party 
was  two-fold,  both  in  denying  the  possibility 
of  the  transportation  and  importation  of  the 
materies  morbi  of  yellow  fever,  and  still  worse 
in  attributing  its  origin  to  local  filth,  the  putrid 
exhalations  of  alleys,  gutters,  docks  and  stag- 
nant water  near  the  city,  thus  making  it  belong 
to  the  class  of  paludal  or  marsh  fevers — an  idea 
overflowing  with  error  and  danger,  yet  still  ad- 
hered to  by  many.  In  Memphis,  1878,  thirty 
out  of  forty-five  young,  healthy,  stout,  volunteer 
physicians  sacrificed  their  lives  to  this  hideous 
error.  The  transportability  and  importation  of 
yellow  fever  has  long  since  been  definitely 
proven;  and  it  is  as  distinct  and  different  from 
malarial  and  other  epidemic  fevers  of  this  coun- 
try as  smallpox  is  from  measles.     While  I  admit 


YELLOW  FEVER.  51 

that  it  is  pre-eminently  a  disease  of  filth, 'yet  I 
agree  fully  with  my  lamented  and  revered 
teacher  the  late  Professor  H.  F.  Campbell  of 
Augusta,  Ga.,  when  he  said:  "We  may  accum- 
ulate filth,  piling  it  up  from  the  pavement  ta 
the  sills  of  the  second-story  windows,  and  it  will 
never  enable  us  to  manufacture  a  single  case  of 
genuine  yellow  fever  without  the  specific 
germ,  any  more  than  we  can  manufacture  a 
case  of  smallpox  without  the  specific  virus  of 
that  disease." 

Dr.  Campbell  had  a  clearer  idea  of,  and 
understood  yellow  fever  better  than  any  modern 
investigator  of  the  disease;  and  only  lacked  the 
certain  knowledge  that  the  disease  owed  its 
specificness  to  a  specific  infection  generated 
from  the  peculiar  filth  of  another  race  and  found 
in  the  holds  of  old  African  slave-ships  to  make 
^  hirn  perfect  master  of  the  whole  subject. 


PART  II. 


NATURE,     ANATOMICAL     CHARACTER, 

SYMPTOMS,    COURSE    AND 

TREATMENT. 

I  shall  have  but  little  to  say  under  the  above 
headings;  for  while  I  claim  that  we  have  more 
exact  and  positive  knowledge,  and  a  clearer 
comprehension  of  the  etiology  of  yellow  fever 
than  of  any  other  known  disease,  yet  I  admit 
that  we  are  still  groping  in  the  dark  as  to  its 
nature  and  cure.  We  know  that  it  is  a  specific 
fever  of  one  paroxysm  lasting  from  thirty-six 
to  seventy-two  hours,  and  thar-it  can  kill  or 
cease  in  these  few  hours.  I  maintain  that  the 
cause  of  this  fever  is  a  specific  infection  en- 
gendered from  a  fermenting,  putrifying  mass  of 
the  natural  excreta  and  morbid  discharges  of 
another  race  occupying  a  lower  order  in  the 
scale  of  the  human  family.  Of  the  physical  and 
chemical  nature  of  this  poison  nothing  is  defi- 
nitely known;  but  reasoning  from  its  observed 
phenomena,  which  are  constant,  we  may  safely 
conclude  that  it  is  an  organized,  disease-pro- 
ducing germ — a  particle  of  living  matter  from 
the  living  matter  of  the  organism  of  that  lower 


YELLOW  FEVER.  53 

_  race,  transportable  in  fomites  of  various  kinds, 
capable  of  growth  and  multiplication  to  an  in- 
definite extent,  and,  in  suitable  conditions,  gen- 
erating the  true  pathogenic  microbe  of  yellow 
fever,  its  last  stage  of  existence.  Hence  these 
microbes  may  hibernate  and  survive  the  winter, 
under  favorable  surroundings,  and  be  revivified 
by  returning  warm  weather;  but  they  have  no 
power  of  reproduction  and  can  give  rise  to  spo- 
radic cases  only,  never  to  an  epidemic.  When 
this  specific  germ  is  introduced  into  a  locality 
.  where  the  conditions  are  suitable,  it  takes  up  its 
march  along  the  surface  of  the  earth  and  begins 
its  function-^rapid  reproduction  and'  genera- 
tion of  the  fever-producing  microbes  which  rise 
and  fill  the  air  of  the  locality.  From  repeated 
observations  made  by  myself  and  many  others  \ 
in  numerous  epidemics,  it  has  been  found  that  | 
the  germs  travel  about  forty  feet  a  day  and  that 
nothing  impedes  or  stops  their  progress,  being 
apparently  governed  and  controlled  only  by  the 
iy        earth's  lines  of  magnetic  force  in  circles. 

I  have  never  entered  an  infected  district  but  it 
recalled  an  incident  of  my  boyhood  days  in  which; 
I  was  teasing  an  immense  rattle  snake  with  a 
long  fishing'pole,  amused  at  the  reptilis's 
ever-increasing  anger.  It  finally  became  so  en- 
raged that,  after  inflicting  its  own  death-wound, 
it  exhaled  from  its  fangs  a  powerful,  sickening 
odor  which  quickly  filled  the  air  and  in  a  few 
seconds  so  affected  me  that  1  seemed  to  be  stand- 


54  YELLOW  FEVER. 

ing  in  a  circle  of  suffocative  yellow  haze.  Drop- 
ping my  pole,  I  ran  for  pure  air  till  exhausted  I 
fell  almost  fainting  upon  the  ground  and  vomit- 
ed freely.  The  odor  perceived  in  localities  in- 
fected by  yellow  fever  and  described  by  many 
as  being  of  a  fishy  character,  never  so  impressed 
my  olfactories,  but  was  the  rather  a  constant  re- 
minder of  the  dissecting  room  of  my  college 
days.  A  person  soon  becomes  so  accustomed  to 
this  odor  as  not  to  perceive  or  notice  it  after  be- 
ing in  the  infected  region  a  few  days;  just  as  one 
who  smokes  does  not  perceive  the  odor  of  tobac- 
co in  his  room,  while  it  will  be  very  offensive 
to  one  entering  who  does  not  use  tobacco. 
This  odor  of  yellow  fever,  as  well  as  the 
microbes,  seems  to  be  governed  by  the  same 
mysterious  force  as  that  which  controls  the 
march  of  the  germs;  and  there  is  often  a  well 
defined  line  of  demarcation  between  the  infected 
and  the  pure  air,  readily  recognized  by  the  odor 
above  mentioned. 

During  the  epidemics  of  1 878-79  in  Memphis, 
Tennessee,  while  gazing  upon  the  icteric  and 
bronzed  countenances  of  the  victims  of  ' 'yellow- 
jack,"  I  was  continually  reminded  of  the  min- 
gling of  the  blood  of  the  white  and  black  races, 
possibly  because  I  was  then  earnestly  engaged 
in  studying  and  investigating  the  long  neglected 
theory  of  Dr.  Audouard;  and  my  mind  may  have 
been  so  influenced  by  his  ideas  as  to  cause  me 
to  view  everything  through  the  medium  of  his 


YELLOW   FEVER.  55 

theory,  just  as  yellow-fever  experts  are  some- 
times charged  with  seeing  all  kinds  of  fevers 
through  .a  yellow  haze  and  diagnosing  them  to 
be  yellow  fever.  The  fear  that  my  mind  might 
have  been  biased  in  this  investigation  has  caused 
me  to  delay  this  writing  from  year  to  year  for 
twenty  years;  and  now  it  is  almost  too  late,  on  ac- 
count of  my  feeble  health  and  failing  physical 
and  mental  vigor,  for  me  to  expect  to  secure  for 
this  idea  the  recognition  which-  it  deserves. 
It  is  a  task  for  me  to  write  now,  for  memory  has 
failed  to  such  an  extent  that  I  have  to  depend 
entirely  upon  records,  and  they  are  in  such  con-" 
fusion  that  I  fear  I  shall  fail  in  making  interest- 
ing and  useful  reading  of  them.  But  the  sub- 
ject has  lost  nothing  by  this  delay,  while  I  have 
gained  experionce  and,  I  trust,  a  moiety  of  wis- 
dom along  with  the  additional  historical  facts 
and  events  of  these  twenty  years  that  sustain 
and  strengthen  my  position  and  my  predictions 
made  at  that  time. 

To  return  to  the  subject  proper:  Yellow  fever 
is  not  in  its  nature  contagious  in  any  sense  of 
the  word;  and  while  we  say  it  is  an  infectious 
and  epidemic  disease,  yet  I  must  insist  that  it  is 
so  only  in  a  limited  sense,  and  not  like  cholera, 
la  grippe,  dengue,  the  plague,  etc.,  which  at 
times  sweep,  with  greater  speed  than  the  wind, 
over  extensive  sections.  It  is  well  known  that 
yellow  fever,  with  rare  exceptions,  never  spreads 
from  an  infected  town  or  city  into  the  surround- 


56  YELLOW  FEVER. 

ing  country,  but  is  frequently  confined  to  a  tier 
of  blocks  or  limited  to  one  side  of  a  street.  The 
only  rational  explanation  of  this  peculiarity  of 
the  disease  is  that  which  I  have  already  given, 
that  it  must  be  under  the  control  of  the  earth's 
lines  of  magnetic  force  of  which  we  as  yet  have 
a  very  vague  and  indefinite  knowledge,  despite 
the  immense  advances  being  made  in  the  con- 
trol and  use  of  electricity  and  magnetism  during 
the  closing  decades  of  this  century. 

The  profession,  at  least  those  who  have  seen 
and  studied  the  disease,  seem  to  be  "a  unit  upon 
the  question  of  contagion;  but  it  strikes  me  that 
their  ideas  and  the  ideas  of  sanitarians  gener- 
ally, more  especially  those  in  charge  of  our  quar- 
antine affairs,  must  be  vague  and  unsatisfactory. 
If  it  is  truly  a  non-contagious  disease,  I  ask  why 
that  unknown  and  unsolved  question,  the  period 
of  incubation,  should  cut  any  figure  in  the 
matter  of  quarantine,  there  being  no  possibility 
of  contagion  from  the  person.  Now  I  want  it 
understood  that  I  am  an  earnest  and  zealous  ad- 
vocate of  rigid,  individual  state  quaratine  based' 
upon  true,  scientific  principles;  and  in  the  case 
of  yellow  fever,  upon  its  two,  prominent  and 
generally  admitted  characteristics,  viz.,  the  un- 
doubtedly easy  transmissibility  and  receptibil- 
ity  of  the  atmospheric  germ,  and  the  entire  ab- 
sence of  contagion  in  the  subject. 

A  quarantine  based  upon  and  administered  in 
accordance  with  these    principles    will  forever 


YELLOW  FEVER.  -    57 

prevent  a  recurrence  of  that  relic  of  barbarism, 
"shotgun  quarantine, "  the  inconvenience  and 
tyranny  of  which  1  experienced  several  times 
last  fall  ( 189'?)  when  it  was  established  all  oyer 
this  broad  State;  and  this  all  on  account  of  the 
insane  and  frenzied  panic  resulting  from  a  few 
cases  out  of  many  thousands  of  that  painful  but 
innocent  disease,  dengue,  having  been  diagnosed 
as  yellow  fever  by  certain  officials  who  ought  to 
have  known  better.  The  recovery  of  every  case, 
so  diagnosed  in  Galveston  and  Houston  may  be 
considered /r/wa/^aV  evidence,  in  the  absence 
of  all  other  information,  that  the  diagnosis  was 
incorrect.  For  we  have  the  unanimous  testi- 
mony of  all  past  observers  and  wiriters  upon 
yellow  fever  that  nearly  all  of  the  first  cases  in 
every  epidemic  of  true  yellow  fever  die.  There 
are  good  reasons  why  this  is  so:  first,  because 
the  peculiar  poison  always  attacks  those  of  fee- 
blest constitution  first;  second,  because  of  the - 
inability  to  make  a  correct  diagnosis  till  several 
deaths  have  established  the  identity  of  the  dis- 
eases. 

It  is  folly  to  claim  that  the  small  mortality 
of  the  so-called  yellow  fever  in  the  South  in 
1897  was  due  to  the  great  improvement  in  mod- 
ern treatment  and  a  better  understanding  of  the 
disease;  for  it  is  an  undeniable  fact  that  not  a  sin- 
gle case  diagnosed  as  yellow  fever  in  Texas  dur- 
ing that  time  had  the  slightest  advantage  of 
that  wonderfully  improved  treatment  of  thej^« 


58  YELLOW  FEVER. 

de  Steele.  And  I  do  not  hesitate  to  say  that  this 
much  vaunted  improvement  in  treatment  is  a 
myth,  and  that  if  we  ever  have  another  serious 
epidemic  of  genuine  yellow  fever  in  this  coun- 
try, which  I  think  is  extremely  doubtful  in  spite 
of  the  many  dire  prophecies  for  this  year,  there 
will  be  the  same  old  death-rate  of  from  twenty- 
five  to  fifty  per  cent. 

But  to  continue  the  subject  of  quarantine: 
The  so-called  period  of  incubation  has  been 
reduced  gradually  by  these  sanitary  scientists  dur- 
ing the  past  twenty  years  from  forty  days  to  five. 
And  if  it  could  be  demonstrated  beyond  doubt 
to  even  be  one  day  or  one  hour  only,  again  I 
ask  what  it  has  to  do  in  the  question  of  quar- 
antine. As  I  have  clearly  shown,  centuries  of 
observation  and  thousands  of  experiences  have 
fully  demonstrated  the  perfect  harmlessness  of 
the  unfortunate  refugee  who  seeks  shelter  and 
hospitality  at  our  hands  in  his  hurried  flight 
from  this  deadly  pestilence.  But  this  statement 
will  require  to  be  more  fully  understood  before 
it  will  be  accepted  even  by  the  modern  sanitary 
scientists,  who  profess  to  believe  and  do  teach 
that  yellow  fever  is  not  contagious,  but  who  yet 
enforce  a  quarantine  and  maintain  camps  for  the 
detention  of  unaffected  persons,  which  act  flatly 
contradicts  all  their  teachings  and  affords 
rational  grounds  for  the  people  in  the  country 
to  establish  * 'shotgun  quarantine."  These  ob- 
servations are  of  times  prior  to  this  fast  period 


YELLOW   FEVER. 


59 


I  of  countless  railroads  and  rapid  transits,  when 

I  the    common    people    apparently     understood 

yellow  fever  better  than  the  medical  profession 
of  today,  experts  included;  for  they  knew  it  was 
not  contagious  and  did  not  hesitate  to  receive 
the  fleeing  refugees  with  open  arms,  caring 
I  tenderly  for  the  sick  and  closing  the  eyes  of  the 

dying,  confident  that  there  was  no  danger  to 
themselves.  And  they  knew,  too,  that  when 
the  speei^;^  exotic  poison  was  introduced  into  a 
city  wh^ri%  obmd  thrive  and  propagate  itxooild 
not  be  confinc(i;iif  i^touse  or  block  by  all-l®8I?I 
I  powers  and  ingenuity  of  man.  --'^iMS 

{  Why   in    those  ^ays  -yello^v    fev<^  "^s    so 

I  rarely,  if  ever,  spread  by  the  refugee  was  due 

mainly  to  the  slow  methods  of  traveling  by  stage 
and  private  conveyance,  so  that  by  the  time  he 
reached  his  destination  the  germs  contained  in 
his  wearing  apparal  and  baggage  were  all  dissi- 
pated or  destroyed  by  nature's  other  great  puri- 
L  fier,  the  air;  and  though  his  blood  was  teeming 

with  the  poison  sufficient  to  finally  produce  the 
disease,  with  black  vomit  and  death,  it  has  been 
fully  demonstrated  that  he  could  no  more  have 
communicated  the  disease  to  others  by  any 
emanations  or  excretions  from  his  body  than 
one  poisoned  with  strychnine  could  communi- 
cate his  terrible  tetanic  convulsions  to  his 
attendants.  As  it  is  clearly  apparent  that  it 
would  require  a  sufficient  amount  of  strychnine 
to  produce  the  same  poisonous  symptoms  in  an- 


6o  YELLOW   FEVER. 

other,  so  it  would  require  a  fresh  supply  of  out- 
side atmospheric  disease-germs  to  .produce  a 
case  of  yellow  fever  among  those  surrounding 
the  bed  of  the  dying  refugee. 

But  in  these  days  of  rapid  transit  the  refugee 
may  pack  his  trunk  in  an  infected  city,  take  a 
fast  train  and  travel  one,  two  or  three  hundred 
miles  in  a  few  hours;  and  while  there  is  not  a 
particle  of  danger  from  his  person,  although  it 
may  be  filled  with  the  deadly  poison,  yet  not 
only  his  apparel  and  his  trunk  but  the  uphol- 
stered car  in  which  he  comes  may  be  full  of  the 
fever-producing  germs  and  become  foci  for  the 
spread  of  the  disease,  if  suitable  conditions  pre- 
vail in  that  locality.  This  explains  the  unprece- 
dented extension  and  spread  of  yellow  fever, 
during  the  past  twenty-five  years,  into  the 
interior  cities  and  towns  from  the  seaboard 
cities  that  have  always  been  considered  its 
natural  habitat. 

All  the  foregoing  statements  have  been  proven 
to  be  true,  times  without  number;  if  it  were  not 
so  it  would  be  the  extreme  of  stupidity  and  folly 
to  say  that  yellow  fever  is  not  contagious.  But 
notwithstanding  these  facts,  the  system  of  quar- 
antine established  and  enforced  in  this  country 
is  a  complete  stultification  of  our  professed 
belief  and  teachings. 

With  a  clear  understanding  of  these  well- 
established  facts  of  the  nature  of  yellow-fever 
poison,  is  it  not  possible  for  scientific  sanitarians 


YELLOW   FEVER.  6i 

to  formulate  and  put  into  operation,  at  far  less 
expense    than    the    present    incongruous    and 
absurd   system   incurs,    a    modified    quarantine 
'  based  upon  rational  principles,  and  one  that  will 
j  command  respect  and  obedience  because  it  will 

j  no  longer  contradict  that  important  and  gener- 

;  ally  acknowledged    principle,   the  impossibility 

of  personal  contagion?  This  system  would  do 
away  with  the  expensive  camps  of  detention  and 
observation;  stop  the  trains  from  an  infected 
city  five  miles  from  the  quarantining  city;  re- 
I  quire  the  refugee  to  take  a  bath,  clothe  him  in  a 

fresh  suit  supplied  for  the  occasion,  and  allow 
him  to  go  to  his  destination  (even  though  he  be 
j  then  suffering  with  the  fever)  in  other  cars  sent 

■  for  the  purpose.     The  train  bringing  him  would 

then  be  returned  to  the  infected  city  and  his 
own  clothes  and  trunk  with  its  contents  would 
be  thoroughly  ventilated  and  sent  after  him 
as  soon  as  possible.  I  say  ventilated  instead 
of  disinfected,  the  term  now  in  vogue,  be- 
cause in  this  era  of  new  things  and  new 
methods,  the  sanitarian,  in  his  search  for 
and  experiments  with  chemical  germicides  or 
some  new  artificial  disinfectant,  seems  to  have 
forgotten  the  only  reliable  germicide  of  olden 
-  times,  nature's  great  disinfectant  and  purifier, 
the  air  in  motion. 

We  have  seen  that  in  consequence^  of  the 
slow  modes  of  open-air  travel  in  the  past  the 
clothing  and  other  fomites  of  the  refugee  were 


62  YELLOW   FEVER. 

purified,  all  the  germs  in  them  being  either  disr 
sipated  or  destroyed;  thus  were  afforded  thou- 
sands of  instances  of  positive  proof  that  yellow 
fever  was  not  contagious,  and  this  was  recog- 
nized by  the  people  at  large  as  well  as  by  the 
profession.  With  such  a  system  of  quarantine 
for  the  interior,  wisely  and  honestly  adminis- 
tered, confidence  would  reign  once  more  among 
the  people;  and  the  frightful  frenzies  that  we 
have  lately  witnessed  would  give  place  to  the 
common  sense  and  common  humanity  exercised 
fifty  to  a  hundred  years  ago. 

What  I  have  said  has  been  in  reference  to  in- 
land quarantine  only,  and  for  the  purpose  of 
showing  the  inconsistency  between  our  pro- 
fessed belief  and  our  actions,  and  also  to  con- 
trast the  present  conduct  of  the  general  public 
with  that  of  fifty  years  ago.  I  have  no  exper- 
ience in  coast  quarantine  whatever;  but  if  my 
ideas  and  theory  of  yellow  fever  are  correct  ( a  few 
more  years  will  either  verify  or  prove  them  false), 
the  point,  for  quarantine  inspection,  at  which  to 
prevent  the  importation  and  introduction  of  the 
infectious  germs  of  this  now  clearly  proven  ex- 
otic disease  would  properly  be  at  its  natural 
habitat.  But  this  can  be  accomplished  only 
through  an  international  compact  between 
Spain,  the  United  States  and  other  interested 
nations. 

It  seems  passing  strange  that  such  distin- 
guished and  able  investigators  and   writers  on 


fi. 


'c 


YELLOW   FEVER.  63 

yellow  fever  as  Doctors  LaRoche,  Chaill^,  Fa- 
g6t,  Ford  and  many  others  should  come  so  near 
I'  the  truth  arid  yet  fail  to  grasp  the  key  to  the 
many  perplexing  mysteries  and  semeiological 
phenomena  of  this  disease;  for  what  Creighton 
said  of  LaRoche  is  applicable  to  all  of  them: 
*'I  find  nowhere  in  his  pages  any  evidence  that 
he  had  mastered  the  facts  of  Audouard's  argu- 
ment or  duly  weighed  its  conclusions,  thus  failr 
ing  to  catch  the  sparkle  of  the  gem  for  which  he 
was  seeking".  These  writers  frequently  men- 
tioned the  proneness  of  yellow  fever  to  originate 
in  the  holds  of  vessels;  but  this  was  too  general, 
and  they  thus  failed  to  catch  Audouard's  idea 
that  it  was  in  sj>ea'a/  vessels  only  in  whose  holds 
was  found  that  peculiar  filth  of  another  race 
which  breeds  it.  Had  Professor  ChailM  clearly 
understood  this  I  do  not  think  he  would  have 
labored  so  ingeniously  as  he  did  to  prove  that 
quarantine  was  ineffectual  against  what  he  then 
thought  was  an  indigenous  disease,  because  the 
rigid  military  quarantine  of  1864  did  not  prevent 
the  occurrence  of  yellow  fever  in  New  Orleans 
that  year. 

But  Professor  Fag^t  testifies  that  the  quar- 
antine was  against  vessels  in  the  merchant 
and  not  those  in  the  naval  service;  while 
Dr.  Fehner  says:  "Vessels  of  war  were  rigidly 
quarantined,  but  those  for  transportation  were 
not."  The  decision  of  this  point  is  rendered 
immaterial   by  the  light  which    later   develop- 


64  YELLOW  FEVER. 

ments  throw  upon  the  true  origin  of  the  yellow 
fever  of  that  year;  for  it  was  found  that  there 
had  been  a  vessel  lying  at  anchor  in  the  river 
since  spring,    which  had  within  its  depths  that 
peculiar  filth  that  under  suitable  conditions  en- 
genders the  specific    infection   of  the   disease. 
I  refer  to  the   gun  boat   Virginia  before  men- 
tioned, an  ex-slaver    which.   Dr.    Brown   says, 
"had  been  captured  in  1863,  shortly  after  land- 
ing  a  cargo  of  Africans  on  the   east   coast  of  , 
Cuba,  taken  to  New  York,  turned  into  a  gun            < 
boat,  and  her  hold  thoroughly  cleansed,  when 
it  was  found  that  her  hull  was  iron,  with  double 
walls  and  that  the  interspace  being  inaccessible           '(^ 
was   never   cleansed.       As   a   consequence   the           >j 
bilge  water  became  so  foul  from  the  impurities            ' 
contained  therein  that  the  pumps  could  not  be            | 
used.     However  she  remained  a  healthy  vessel            j 
till  the  fall  of  1864,  when  in  September  she  was 
hauled  onto  the  river  bank  for  repairs,  pumped 
out  dry  and  cleaned."     As  a   natural    sequence 
to  this  proceeding  came  an  outbreak  of  yellow 
fever. 

The  many  acrimonious  controversies  that  have 
occurred  about  this  disease  were  the  result  of 
the  great  difference  of  opinion  as  to  its  true 
origin,  the  nature  of  its  poison,  its  portability, 
contagiousness  and  period  of  incubation,  and 
also,  as  it  would  now  seem,  the  lack  of  knowl- 
edge of  the  whole  truth  about  the  disputed 
points,  on  the  part  of  both  parties  to  the  debate. 


VELLOW   FEVER.  65 

Prof.  Chains,  after  summarizing,  under  three 
heads,  the  various  theories  of  yellow  iever  held 
by  the  profession,  adds  a  fourth,  a  part  of  which 
is  as  follows:  ^'Yellow  fever  is  produced  by 
two  poisons,  or,  rather,  by  one  which  produces 
different  results  depending  on  the  place  where  it 
is  generated,  the  quantity  generated,  and  the 
different  conditions  of  these  poisons.  Thus  the 
poison  sometimes  is  either  contagious  or  porta- 
ble, or  both,  and  at  other  times  is  not." 

Now,  while  yellow  fever  is  said  to  be  identical 
in  the  various  climates  where  it  prevails,  it  is 
very  natural  to  suppose  that  the  nearer  it  pre- 
vails to  its  origin  the  more  virulent  and  destruc- 
tive will  be  its  effects.  It  is  in  this  way  I  ac- 
count for  its  unexampled  fatality  and  enormous 
rate  of  mortality  in  Spain;  for  her  contraband 
ships  could  not  be  repaired  or  cleaned  in  any 
other  ports;  and  after  discharging  their  cargoes 
of  West  Indian  and  Brazilian  products,  which, 
have  themselves  been  proven  to  be  splendid  fo- 
mites  for  carrying  the  germs  of  the  disease,  they 
sometimes  lay  from  three  to  five  weeks  in  the 
harbor,  undergoing  repairs,  scouring  their  foul 
holds  and  pumping  their  filthy  bilges  into  the 
water  of  the  bay. 

The  rate  of  mortality  in  yellow  fever  has  been 
less  in  the  United  States  than  in  any  other  coun- 
try, because  the  poison  was  more  diluted  and 
weakened  in  our  harbors;  and,  as  I  have  shown, 
since  the  complete  suppression  of  the  slave  trade 


66  YELLOW   FEVER. 

they  have  been  thoroughly  cleansed  of  every  trace 
of  it  by  the  action  of  the  waves  and  tides  of  the 
Atlantic,  so  that  yellow  fever  has  ceased  to  re- 
cur in  them  as  an  indigenous  disease.  Hence 
my  prediction  that  it  is  nearing  the  end  of  its 
existence  and  can  be  eradicated  by  the  properly 
directed  efforts  of  man.  If  this  hope  is  fulfilled, 
it  will  prove  the  correctness  of  the  views  of  those 
who  now  hold  that  yellow  fever  is  a  specific  dis- 
ease J"z^/^^;z^m;  but  I  find  Prof.  Fag^t,  in  1870, 
exclaiming  against  this  expression  found  in 
Prof.  Atken's  ''Practice  and  Science  of  Medi- 
cine," saying:  "Yet,  it  has  no  characteris- 
tic or  pathognomonic  sign;  black  vomit  even  is 
not  such  for  it.  It  is  only  by  the  agglomeration 
and  co-ordination  of  its  symptoms,  by  its  origin 
and  modes  of  importation,  development  and  ces- 
sation, by  its  march  especially,  and  by  some  other 
peculiarities,  that  it  may  be  distinguished  from 
other  types;  it  thus  essentially  constitutes  a 
truly  morbid  species."  Strange  words,  truly,  to 
come  from  him  who  taught  the  profession  that 
a  regular  decrease  of  pulse  with  an  increasing, 
temperature  from  the  first  or  second  day  to  the 
fourth  was  an  unfailing  pathognomonic  symp- 
tom of  yellow  fever  not  found  in  any  other  fe- 
brile disease,  and  who  has  further  taught  that  it 
strongly  individual  in  its  characteristics. 

But  as  surely  and  certainly  as  the  historical 
facts  and  truths  of  the  disease  revealed  in  its 
nineteenth-century   record    demonstrated    that 


YELLOW  FEVER.  67 

yellow  fever  is  not  a  morbid  species,  but  a 
disease  sui  generis  and  peculiar,  so  surely  is  time 
proving  that  this  much-relied-upon  pathogno- 
monic sign  is  no  more  peculiar  and  characteristic 
of  it  than  even  are  black  vomit  and  jaundice. 
While  for  twenty-five  years  I  have  relied  largely 
upon  this  sign,  but  more  upon  the  fact  of  its  be-^ 
ing  a  fever  of  one  simple  paroxysm,  as  an  aid  to 
diagnosis,  yet  I  have  always  been  convinced  that 
there  is  no  one  single  pathognomonic  symptom 
by  which  the  observer  may  be  enabled  to  say 
positively,  ''This  is  yellow  fever."  The  entire 
group  of  disease  phenomena  alone  furnishes  the 
key  to  a  correct  diagnosis,  and  which  when  ana- 
lyzed exhibits  the  strong  individual  characteris- 
tics of  yellow  fever. 

The  period  of  incubation  is  a  myth,  and  being 
an  unknown  quantity  is  of  no  value  in  diagnosis. 
There  is  no  need  of  an  incubating  nidus  in  the 
organism;  for  the  germs  incubate  in  the  atmos- 
phere, and  every  person  in  the  infected  area  in- 
hales and  swallows  myriads  of  these  disease- 
producing  bacilli.  But  Pasteur  proved  that  these 
micro-organisms  cannot  infect  the  body  while 
the  vital  equilibrium  is  perfectly  undisturbed  (a 
condition  unfortunately  very  infrequent);  hence^ 
the  great  difference  in  time  in  which  different  in- 
dividuals in  the  same  epidemic  succumb  to  the 
poison,  owing  to  the  individual  powers  of  re- 
sistance; some  escape  its  effects  altogether. 

I    myself   passed    unscathed    through   half   a 


68  YELLOW  FEVER. 

dozen  epidemics,  and  when  I  finally  succumbed 
it  was  because  my  vitality  was  below  its  normal. 
But  my  attack  was  an  unusually  light  one,  fever 
lasting  only  thirty-six  hours,  with  but  little 
cephalalgia  or  other  pain.  I  left  my  bed  on  the 
fifth  day  and  was  out  seeing  patients  on  the 
eighth.  This  imprudence,  with  over-eating  and 
the  care  of  five  children  suffering  with  the  same 
disease,  caused  a  relapse  eight  days  later  which 
put  me  in  bed  for  six  weeks.  On  the  day  of  re- 
lapse I  returned  home  from  making  calls  at 
three  o'clock  p.  m.,  feeling  well  but  a  little 
jaded;  ate  a  hearty  dinner  and  lay  down  for  a 
short  nap.  I  must  have  slept  heavily;  and  as  I 
had  been  losing  sleep  my  wife  did  not  allow  me 
to  be  disturbed  till  5:30  p.  m.,  when  she  came  in 
with  a  lamp  and  aroused  me.  In  that  heavy  sleep 
of  two  hours  and  a  half  I  had  become  deeply 
jaundiced;  hemorrhage  from  the  nasal  and  buc- 
cal membranes  had  commenced,  and  I  had  swal- 
lowed a  considerable  quantity  of  blood  which  so 
nauseated  me  that  on  awakening  I  vomited  freely 
and  threw  up  such  a  large  quantity  of  dark  col- 
ored undigested  food  that  my  wife  and  my  friend, 
Dr.  A.  H.  Ketchum  then  fresh  from  college, 
thought  I  had  the  black  vomit  and  so  reported; 
but  it  was  not  true,  and  I  never  vomited  or  was 
nauseated  again  during  my  six  weeks'  confine- 
ment. There  was  never  the  least  sign  of  fever 
and  my  pulse  continued  to  descend  until  it 
reached  forty  per  minute,  then,  after  I  was  able 


YELLOW   FEVER.  69 

to  be  out  again,  slowly  ascended  to  one  hun- 
dred and  oscillated  back  and  forth  for  months 
before  it  became  steady  at  seventy-four,  ten  beats 
less  than  my  normal  pulse  was  before  the  attack. 
I  had  a  narrow  escape  and  only  speak  of  my 
case  at  this  length  because  so  many  lose  their 
lives  by  the  same  imprudent  course  that  I  pur- 
sued; and  I  earnestly  desire  to  impress  upon 
physicians  that  it  is  our  duty  to  warn  ever  yel- 
low-fever patient,  no  matter  how  light  the  fever 
has  been,  of  the  great  danger  and  risk  to  life 
from  getting  up  too  soon  and  indulging  the  ap- 
petite; for,  while  many  escape  without  further 
trouble,  I  have  known  patients,  who  were  being 
congratulated  on  their  quick  recovery,  to  die  as 
early  as  forty-eight  hours  and  as  late  as  six  weeks 
after  the  fever.  The  one,  two  or  three  days' 
fever,  during  the  lifetime  of  the  microbes  as  they 
ravage  the  life-stream  and  afterwards  pollute  it 
with  their  carcasses,  is  by  no  means  the  whole 
of  the  disease.  It  is  really  only  the  first  stage. 
The  calm  following  the  febrile  stage  is  a  very  de- 
ceptive one  and  is  often  a  more  or  less  profound 
state  of  collapse,  the  result  of  the  destructive 
changes  wrought  in  the  blood-stream  by  the  poi- 
son, and  often  escapes  the  eye  of  the  busy,  over- 
worked practitioner  until  it  is  too  late.  It  is 
during  and  after  this  stage  of  calm  that  organic 
changes  begin;  and  their  extent  and  gravity, 
with  the  consequent  depression  of  vital  proc- 
esses,     depend     upon     the    extent   of    blood- 


70  YELLOW   FEVER. 

changes  and  the  amount   of  paralysis  sustained 
by  the  great  sympathetic. 

But  to  finish  the  subject  of  incubation:  Dr. 
Dowell  and  other  authors  on  yellow  fever  re- 
port numerous  instances  of  persons  who,  having 
fled  from  an  infected  city  to  the  country /Or  a 
distant  town,  were  attacked  from  three  to  six 
weeks  afterward;  and  these  authors  adduce  these 
facts  as  positive  proof  that  the  incubation  period 
may  be  that  long.  But  this  can  be  more  ration- 
ally explained  by  the  now  well  established  fact 
of  the  easy  portability  of  the  disease-producing 
germs  and  microbes  in  the  wearing  apparel  and 
baggage  of  the  refugees.  These  people  packed 
their  trunks,  generally  of  the  largest  Saratoga 
pattern  and  several  of  them,  in  the  infected  city, 
thereby  enclosing  a  portion  of  the  disease-laden 
air  with  their  winter  garments,  which  they  al- 
ways carry  knowing  they  will  not  be  able  to  re- 
turn till  after  a  freeze.  The  late  development  of 
the  fever  in  them  was  not  due  to  incubating 
germs  inhaled  while  in  the  city,  but  to  their  in- 
haling those  enclosed  microbes,  ^^compagnons 
de  voyage,''  upon  opening  their  trunks  at  the 
periods  mentioned.  Their  nervo-vital  powers 
having  been  lowered  by  the  excitement,  fright 
and  fatigue  which  they  had  undergone,  they  fell 
an  easy  prey  to  the  action  of  the  poison.  Nu- 
merous instances  of  this  kind  are  on  record 
which  have  been  thoroughly  investigated;  and 
abundant  evidence,  too  plain  and  convincing  to 


k 


1;  -  YELLOW   FEVER.  71 

F         be  gainsaid,  has  been  found  to  prove  that  my  ex- 

j^:         planation  is  the  correct  one. 

fj:  Reasoning  from  analogy,  I  am  of  the  opinion 

that  when  this  deadly  animal  poison  gains  an 
entrance  into  the  blood-stream,  it  begins  its 
work  at  once  and  acts  as  rapidly  as  the  venom 
of  the  rattlesnake.  In  every  epidemic  I  have 
seen  numerous  instances  in  which  persons  were 
stricken  down  within  twenty-four  hours  after 
entering  the  infected  atmosphere;  and  the  rea- 
son that  every  non-immune  is  not  thus  affected 
is  that  the  vital  energy  of  the  lungs  and  alimen- 
tary canal  is  sufficient  to  resist  the  entrance  of 
the  microbes  into  the  circulation  and  also  to  de- 
stroy them.  As  soon  however  as  a  breach  is 
found  in  a  weakened  organism  the  microbes 
rush  in,  rapidly  fill  the  blood-stream,  and  the 
work  of  destruction  and  death  begins.  Instantly 
all  is  confusion  and  terror;  and  urgent,  pleading 
messages  for  help  flash  over  the  nerves  from 
every  organ  and  tissue  to  the  great  central  organ 
of  nervo-vital  energy,  the  brain.  So  numerous 
and  rapid  are  these  messages,  saying  that  func- 
tion is  impossible  with  such  a  blood  supply,  that 
the  poor  brain,  suffering  from  the  same  cause 
also,  becomes  so  irritated,  confused  and  help- 
less that  in  dispair  it  flashes  to  the  outer  world 
the  concentrated  impressions  of  the  entire  or- 
ganism, and  there  appears  upon  the  countenance 
an  expression  of  surprised  horror,  followed 
quickly  by  one  of  fierce  inquiry  in  which  the 


72  YELLOW   FEVER. 

eyes  seem  to  pierce  the  inmost  soul  of  the  piiy- 
sician,  seeking  help  and  hope;  and  seeing  only 
dispair  there,  the  expression  of  that  emotion 
spreads  over  the  countenance  as  the  last  ray  of 
expiring  intelligence,  and  the  whole  frame  be- 
comes convulsed.  The  dumbfounded  physician 
and  attendants  can  only  watch,  powerless  to 
help.  Convulsion  succeeds  convulsion  till  at 
last  the  material  body  of  the  miserable  victim 
exhausted  dies,  exhibiting  all  the  phenomena  of 
putrid  decomposition. 

The  expressions  of  the  emotions  of  surprise 
and  horror  appear  so  nearly  simultaneously  that 
I  designate  the  combination  as  ''surprised  hor- 
ror." I  have  never  seen  this  expression  of  the 
countenance  in  any  other  disease;  still  it  cannot 
be  strictly  considered  pathognomonic,  except 
in  a  limited  sense,  as  it  is  seen  only  in  those 
rapidly  fatal  cases  constituting  about  ten  per 
cent  of  the  whole  number.  I  mention  it  because 
it  is  only  one  of  the  ensemble  of  expressions  that 
go  to  make  up  the  peculiar  facies  of  yellow 
-fever.  I  have  personal  knowledge  of  its  appear- 
ance being  deferred  in  quite  a  number  of  cases 
till  that  deceptive  stage  of  calm  just  after  the 
subsidence  of  the  febrile  stage;  and  in  every  in- 
stance the  patient  was  sleeping  quietly,  and  the 
expression  was  produced  by  the  shock  from  be- 
ing suddenly  awakened  by  a  loud  noise,  as  the 
blowing  of  a  steam  whistle  or  _  the  ringing  of  a 
church  bell  near  by. 


YELLOW  FEVER.  73 

One  such  case  was  that  of  a  man  who  occu- 
pied a  room  in  the  second  story  of  a  building  on 
The  Strand,  Galveston,  Texas,  during  the  epi- 
demic of  1859.  He  had  passed  through  the  fever 
safely  and,  though  recognized  as  very  ill,  hopes 
were  entertained  of  his  recovery.  He  slept  qui- 
etly through  the  night  tillSiOO  o'clock  a.  m., 
when  a  Trinity  River  steamer  arrived  at  the 
wharf  just  under  his  window  and  began  to  blow 
its  discordant  whistle.  At  the  first  blast  the  pa- 
tient sprang  up  on  the  side  of  the  bed  and  with 
hands  over  his  ears  said,  **If  that  whistle  does 
not  stop  in  five  minutes,  I  am  a  dead  man." 
Knowing  the  custom  of  the  boat  to  blow  half  an 
hour,  a  messenger  was  hurriedly  sent  to  have  the 
noise  stopped;  but  before  it  ceased  that  horrible 
expression  appeared  upon  the  sick  man's  coun- 
tenance and  was  followed  by  a  convulsion  which 
soon  closed  the  scene  in  death. 

Another  was  that  of  Mrs.  H.,  Calvert,  Texas, 
1873.  She  passed  through  three  days'  intense 
fever  but  did  not  exhibit  the  amount  of  prostra- 
tion usually  seen  in  the  stage  of  calm.  I  saw 
her  at  midnight,  twelve  hours  after  the  fever 
had  subsided.  She  was  feeling  so  well  that  she 
insisted  that  her  lady  friend  who  was  nursing 
her  should  go  to  bed  and  let  her  thirteen-year- 
old  daughter  lie  by  her  on  the  bed  to  call  if  any- 
thing was  needed.  She  slept  quietly  till  5:00 
a.  m.,  when  a  switch  engine,  standing  upon  the 
track  forty  or  fifty  feet  from  her  window,  having 


74  YELLOW   FEVER. 

gotten  up  steam,  blew  a  sudden  shrill  whistle 
which  instantly  awakened  her  and  she  sprang 
out  of  bed  in  great  alarm,  with  eyes  wide  open 
and  wildly  rolling  as  if  she  saw  all  the  hob-gob- 
lins ever  imagined.  Her  little  daughter  pushed 
her  back  upon  the  bed  and  called  for  help.  Liv-. 
ing  only  a  block  distant,  I  was  at  her  bed-side  in 
less  than  ten  minutes;  but  alas!  those  invariably 
fatal  convulsions  had  begun,  and  they  continued 
until  she  died  at  ten  o'clock  that  morning. 

That  common  and  annoying  nuisance,  the  loud 
and  long  blowing  of  whistles,  should  be  strictly 
prohibited  by  law  during  an  epidemic  of  yellow 
fever;  for  it  is  well  known  that  many  a  poor  suf- 
ferer, with  life  trembling  in  the  balance,  has  had 
the  scale  turned  against  him  by  their  unearthly 
and  at  all  times  needless  screeches.  In  this 
city  of  railroads,  Houston,  Texas,  where  some 
fifteen  or  twenty  either  center  or  pass  through, 
with  its  several  oil  mills,  ice,  beer  and  other  fac- 
tories in  active  operation,  discordant  and  disa- 
greeable steam  whistles  are  to  be  heard  almost 
constantly  day  and  night,  often  preventing  con- 
versation for  the  time  being.  This  should  not 
be  permitted  at  any  time;  for  there  are  nervous 
sick  people  all  the  time,  and  the  shocks  from 
these  piercing,  ear-splitting  sounds  is  very  inju- 
rious to  them. 

I  said  these  unfortunate  patients  die  with  all 
the  signs  of  putrid  decomposition;  and  this  is 
the  only  anatomo-pathologic  feature  or  charac- 


YELLOW  FEVER. 


75 


teristic  of  any  importance  that  I  shall  notice  in 
detail;  for  in  my  search  for  diagnostic  signs  I 
have  been  in  the  habit  of  studying  the  disease 
in  the  living  subject  in  preference  to  the -ca- 
daver, and  consider  it  a  waste  of  time  to  study 
the  useless  natural  history  of  the  latter.  The 
above  pathological  fact  was  first  brought  to  my 
attention  years  ago  by  an  observing  undertaker, 
in  the  case  of  one  of  my  patients'  who  had  died 
within  forty-eight  hours  after  the  attack  began. 
He  said  to  me,  "Dr.  I  want  to  get  that  man  into 
his  coffin  just  as  soon  as  possible,  and  if  you 
will  go  with  me  I  will  show  you  how  very  rap- 
idly decomposition  goes  on  in  those  who  di«  so 
.  quickly  of  yellow  fever;  you  can  explain  to  the 
family  my  apparently  indecent  haste."  ■  I  found 
that  he  had  to  use  great  care  in  washing  the 
corpse  lest  the  skin  should  slip  off;  and  the 
muscles  had  a  peculiarly  soft,  doughy  feeling 
which  produced  the  impression  that  with  a  little 
more  pressure  the  fingers  would  easily  penetrate 
the  yielding  mass.  The  odor  of  putridity  was 
exhaling  from  all  parts  of  the  body.  Since  then 
I  have  closely  observed  all  such  cases,  and  have 
invariably  found  decomposition  of  a  putrid  char- 
acter progressing  far  more  rapidly  than  I  have 
ever  seen  it  in  any  other  disease,  both  before 
and  after  death.  This  decomposition,  the  result 
of  the  profound  blood  changes  wrought  by  the 
poison,  undoubtedly  begins  with  the  first  en- 
trance of  the  microbes  and  is  continuous  until 


pp 


76  YELLOW  FEVER. 

the  fatal  termination;  then  of  course  it  becomes 
more  rapid,  all  vital  resistance  having  ceased. 
This  rapid  decomposition  is  greater  and  more 
readily  observed  in  all  those  quickly  fatal  cases 
in  which  the  system  is,  as  it  were,  overwhelmed 
by  the  immense  quantity  of  poison  entering  it; 
still  it  occurs  in  all  cases,  to  a  greater  or  less 
extent,  even  in  those  who  recover. 

This  tendency  to  rapid  decomposition  is  de- 
nied by  some  observers,  and  admitted  by  others. 
These  latter,  however,  go  a  step  too  far  in  de- 
ducing the  theory  that  this  rapid  decomposition 
constitutes  a  condition  which  causes  a  rapid  in- 
crease of  bacteria,  fungi  and  other  simple  organ- 
isms that  become  carriers  of  the  poisons  and 
thus  aid  in  disseminating  the  disease.  This  is  an 
utter  impossibility,  for  there  is  no  longer  any 
yellow-fever  poison  in  that  dying  or  dead  body. 
The  specific,  yellow-fever  microbes  perish  in  the 
system  amid  the  wreck  and  ruin  wrought  by 
them  just  as  quickly  as  does  the  rattlesnake 
from  its  own  venom  self-inflicted.  If  this  were 
not  true  we  should  be  compelled  to  admit  that 
yellow  fever  is  contagious  from  the  person, 
,  I  have  repeated  this  because  I  want  the  profes- 
sion to  get  a  clear  understanding  of  the  idea  and 
to  become  familiar  with  it;  for  it  was  a  long  time 
before  Prof.  H.  F.  Campbell  could  get  this 
truth  to  penetrate  my  dull  brain  so  that  I  was 
able  to  thoroughly  understand  it;  and  without 
the  proper  comprehension  of  the  whole  idea  it 


YELLOW   FEVER.    ^  77 

is  impossible  to  comprehend  the  non-contagious- 
ness of  yellow  fever  from  the  person,  when  there 
are  so  many  instarices  on  record  of  an  epidemic 
having  started  in  an  hiterior  town  soon  after  the 
arrival  of  refugees  from  an  infected  city.  Even 
Prof.  Chaili^  admitted  that-he  found  it  difficult 
to  comprehend  the  distinction  apparently  made 
between  the  non-contagiousness  from  a  patient 
in  his  clothes  and  the  portability  of  the-disease 
by  the  same  clothes.  But  I  would  be  considered 
prolix  and  tiresome  if  I  again  repeated  what  has 
already  been  mentioned  twice  in  the  preceding 
pages,  and  I  hope  my  readers  are  now  able- to 
fully  and  clearly  understand  the  point  in  ques- 
tion. 

It  would  seem  that  the  anatomo-pathologic 
lesion  above  mentioned  ought  to  be  sufficient 
under  this  head;  but  I  will  mention  briefly  two 
others  which  I  observed  frequently  while  mak- 
ing some  investigations  in  Memphis  in  1879.  Of 
twenty-five  cadavers  the  kidneys  m  twenty  were 
enormously  hypertrophied -and  the  parenchyma 
and  cortical  substance  were  so  softened  that  the 
finger  could  be  easily  pushed  into  the  mass.  The 
other,  which  I  found  frequently,  was  defibrinated 
blood  and  granules  of  black  vomit  extravasated 
"into  the  cellular  tissue  along  the  track  of  the 
larger  vessels  of  the  vascular  system  and  from 
the  dilated  capillaries.  This  was  due  to  thedi- 
latation  and  softening  of  the  walls  of  the  vessels 
in  consequence  of  the  paralysis   of  the   sympa- 


78  YELLOW  FEVER. 

thetic.  These  two  lesions  may  be  considered 
a  part  of  the  universal  decomposition  going  on 
in  the  organism. 

But  in  my  opinion  the  cadaver  is  not  the  right 
place  to  seek  for  diagnostic  symptoms;  and 
it-^is  extremely  doubtful  if  the  pathological 
anatomist  ever  lived  who  became  so  ex- 
pert and  familiar  with  all  pathological  lesions 
occurring  in  the  body,  from  any  cause,,  that  he 
could  by  a  careful  and  complete  postmortem  ex- 
amination, and  without  any  prior  knowledge  or 
suspicion  of  the  causes  of  death,  pick  out  in  a 
dozen  or  more  cadavers  those  that  were  known 
to  have  died  of  yellow  fever. 

The  living  subject  should  be  the  field  for  re- 
search, and  the  blood  should  be  the  special  part 
investigated;  and  this  investigation  should  be 
begun  the  moment  it  is  known  that  the  enemy 
has  gained  an  entrance.  The  blood  is  the 
point  of  invasion,  the  material  which  constitutes 
both  the  food  and  the  tomb  of  the  inyisible, 
mysterious  and  deadly  foe.  All  the  immediate 
effects  the  irregular  or  paralyzed  nerve  action, 
organic  or  functional  derangements,  and  all  ar- 
rest of  vital  metabolic  processes  are  secondary, 
and  are  being  continuously  augmented  by  the  re- 
flexes from  the  irritated  and  rapidly  weakening 
nerve  centers,  all  of  which  reflexes  result  from  the 
destructive  changes  produced  in  the  live  stream. 
This  rapid  destruction  of  the  red  blood  corpus- 
eels  is  followed  by  arrest  of  the  functions  of  the 


YELLOW  FEVER. 


79 


liver  and  kidneys;  and  on  account  of  this  impaired 
or  suppressed  elimination  and  the  consequent 
accumulation  of  bileand  excrementitious  constit- 
uents of  the  urine,  all  of  which  add  to  and  in- 
crease the  disorder,  distress  and  suffering  reign 
in  the  system. 

Doubtless  every  practitioner  who  has  had 
much  experience  with  this  disease  has  seen,  as 
I  have,  patients  die  in  from  twenty-four  to  thir- 
ty-six hours  from  the  commencement  of  the  dis- 
ease; then  am  I  not  justified  in  saying  that  I  be- 
lieve that  the  poison  begins  to  act  as  soon  as  it 
gains  an  entrance,  and  that  this  work  of  de- 
struction is  continuous  and  as  rapid  as  that  of 
the  venom  of  the  rattlesnake?  The  frequent 
analysis  of  the  blood  during  the  first  twenty- 
four  hours  of  the  attack  furnishes  the  best  diag- 
nostic points  found  in  the  ensemble  of  pathogno- 
monic signs  by  which  yellow  fever  is  recognized; 
but,  as  I  have  said  before,  there  is  no  one  single 
distinct  symptom  by  which  it  can  be  diagnosed 
at  a  glance. 

It  requires  a  close  observation  for  several 
hours  by  a  practiced  diagnostician  to  make  a 
positive  and  unerring  diagnosis,  although  it  is  a 
specific  and  unique  disease.  But  the  same  dif- 
ficulty is  found  prevailing  in  nearly  all  other 
specific  diseases;  for  who  can  sit  down  by  the 
bedside  of  a  patient  suffering  with  a  high 
grade  of  fever,  on  the  first,  second  or  even  on 
the  third  day  of  its  continuance,  and  diagnose  it 


8o  YELLOW   FEVER. 

"Variola!,"  having  no  knowledge  that  his  patient 
has  been  exposed  to  the  contagion  of  that  dis- 
ease? No  one;  even  in  this  enlightened  day. 
Still  I  believe  that  such  a  sign  taken  in  connect- 
tion  with  the  assemblage  of  known  symptoms 
does  exist  not  only  in  variola  but  also  in  yellow 
fever  and  all  specific  diseases,  as  has  been  found 
in  pertussis  and  rubeola;  when  I  said  there  was 
none  in  yellow  fever,  I  meant  none  had  been 
discovered  as  yet. 

But  suppose  there  was  one  well-known,  clear, 
distinct,  and  infallible  symptom  that  would  en- 
able us  to  make  a  correct  diagnosis  at  once,  cut 
bono'?  Has  the  physician  discovered  a  balm 
that  will  cure?  Has  he  formulated  a  therapeu- 
tic measure  or  compounded  an  elixir  that  will  in 
the  smallest  degree  modify,  shorten  or  abort 
this  terrible  disease?  Has  the  profession,  as  a 
whole,  advanced  a  single  iota  in  treatment  since 
the  days  of  the  great  Dr.  Rush  with  his  lancet 
and  huge  doses  of  calomel  and  quinine?  Alas! 
far  from  it;  and  now  at  this  period  of  life,  having 
retired  from  active  practice  and  being  simply  a 
looker-on  in  the  Venice  of  medicine,  though  one 
intensely  interested  in  all  that  pertains  to  im- 
provements in  the  profession  in  which  I  have 
labored  so  long,  the  conclusion  is  forced  upon 
me  that  the  profession,  by  over-medication, 
often  prolongs  a  case  by  adding  drug-disease  to 
the  original  one  and  thus  frequently  prevents  the 
recovery  of  some  who  otherwis^e  would  get  ^ell. 


YELLOW  FEVER.  8i 

The  experience  and  knowledge  gained  in  lat- 
er  years  convinces  me  that  when  in  my  first 
years  of  practice  I  gave,  as  I  had  been  taught, 
ten  to  twenty  grains  of  calomel,  frequently  add- 
ing twenty  grains  of  quinine  as  an  initial  dose 
in  the  treatment  of  yellow  fever,  I  had  aided  the 
enemy  in  destroying  its  victim;  but  I  am  thank- 
ful to  say  that  I  earned,  by  my  conservative 
course  afterwards,  the  equivocal  compliment 
from  a  wealthy  client  who  said,  in  advising  oth- 
ers to  employ  me,  that  if  I  did  no  good  I  was 
sure  to  do  no  harm. 

But  to  close  the  subject  of  symptoms  and  diag- 
nosis I  will  say:  Yellow  fever  is  more  easily 
recognized  in  the  first  stage  than  is  any  other 
one  of  the  special  diseases.  When  a  physician 
who  is  perfectly  familiar  with  bilious  fever,  un- 
expectedly and  with  no  suspicion  of  its  nature, 
meets  his  first  case  of  yellow  fever,  he  is  imme- 
diately impressed  with  the  conviction  that  it  is 
something  different  from  what  he  has  ever  seen 
before — a  something  in  the  tout  ensemble  of  the 
facies,  indescribable  by  words,  which  impresses 
itself  on  the  close  observer  in  a  way  never  to  be 
forgotten,  and  furnishes  him  an  invaluable  aid 
to  a  quick  diagnosis  in  the  future.  It  is  the  fa- 
cies vultuosa^  caused  by  stasis  of  the  blood  in 
the  capillaries,  a  consequence  of  the  primary 
weakening  effect  of  the  poison  upon  the  heart. 

This  stasis  produces  a  reddish,  florid  color, 
inclining  to  purplish  upon  the  forehead,  face  and 


82  YELLOW   FEVER. 

extending  down  over  the  neck  and  the  uppei 
part  of  the  chest,  afterwards  changing  to  a  bronze 
tint,  or  to  an  orange-yellow  color  if  general  jaun- 
dice is  to  ensue.  In  the  eyes,  which  are  red- 
dened and  turgid,  sometimes  blood-shot,  are 
to  be  seen  at  first  expressions  of  apprehension, 
anxiety  and  inquiry  soon  changing,  in  serious  and 
fatal  cases,  to  those  of  apathy,  wild,  fierce  de- 
lirium, or  inexpressible  horror,  depending  upon 
the  temperaments  of  the  patients.  There  is 
generally  severe  headache  and  much  pain  in  the 
back  and  limbs,  attended  with  great  restlessness 
and  nervous  agitation,  all  due  to  and  produced 
by  the  rapid  accumulation  of  bile  and  the  con- 
stituents of  the  urine  in  the  blood. 

The  pulse  is  the  next  noticeable  symptom 
fwhich  will  arrest  the  attention  of  the  investiga- 
jtor.  It  differs  greatly  in  these  two  fevers  which 
j[or  two  centuries  were  erroneously  regarded  as 
fldentical  in  nature,  only  differing  in  degree,  and 
/arising  from  the  same  cause.  This  also  furn- 
ishes additional  aid  in  diagnosis;  for  in  bilious 
fever,  during  the  first  twelve  to  eighteen  hours,  - 
it  is  full  and  frequent — one  hundred  and  twenty 
to  one  hundred  and  thirty  per  minute — with  in- 
creased tension  and  force;  while  in  yellow  fever 
the  pulse  reaches  its  acme,  never  over  one 
hundred  and  twenty,  in  the  first  three  to  six" 
hours;  and  the  physician,  at  his  first  visit,  gen- 
erally finds  it  between  ninety  and  one  hundred,, 
soft  and  full,  with  but  little  force  or  tension;  and 


YELLOW   FEVER.  83 

also  finds  a  remarkable  discrepancy  and  want  of 
co-ordination  between  it  and  the  temperature. 
The  time  of  the  onset  of  yellow  fever  is  at  night, 
almost  invariably  between  nine  o'clock  at  night 
and  three  in  the  morning;  while  no  type  of  pa- 
ludal fever,  according  to  my  observation,  ever 
begins  at  that  time  of  night.  This  fact  and  the 
course  pursued  by  yellow  fever,  the  most  unique 
yet  regular  of  any  known  disease,  both  afford 
important  and  valuable  help  in  diagnosis.  In 
fact,  each  and  every  phenomenon  in  the  assem- 
blage constituting  the  disease  may  be  truthfully 
said  to  be  pathognomonic  of  it;  and  the  physi- 
cian who  familiarizes  himself  with  them  singly 
or  as  they  appear  inrthe  group  becomes  as  nearly 
infallible  in  diagnosing  this 'disease  as  it  is  pos- 
sible for  man  to  be.  This  is  no  exaggeration. 
He  can,  by  familiarity  with  the  symptoms,  as 
readily  distinguish  yellow  fever  from  dengue  and 
bilious  fever  as  he^can  distinguish,  by  color  and 
other  characteristics,  the  pure  blooded.  African 
from  the  fairest  Castilian  who  ever  vailed  her 
unsurpassed  lovliness  from  the  vulgar  gaze. 

Having  spent  my  long  life  wholly  in  paludal 
regions,  and  in  localities  frequently  visited  by 
yellow  fever,  it  was  but  natural  that  T should 
have  made  these  two  most  important  fevers  the 
subjects  of  special  study  and  investigation. 

But  when  I  first  began  my  investigations,  my 
knowledge  and  ideas  of  these  diseases  were  too 
limited,  vague  and  crude  to  be  of  any  satisfac- 


84  .  YELLOW   FEVER. 

tion  to  myself  or  real  benefit  to  others;  still  I 
persevered,  under  many  difficulties  and  discour- 
agements, determined  to  acquire  all  the  knowl- 
edge that  had  been  or  could  be  acquired  about 
them;  till  at  last  I  became  not  only  very  success- 
ful in  treating  bothj  but  could  also  tell  my  pa- 
tient'the  day  and  the  hour  when  the  malarial  fever 
would  return  as  surely  as  the  sun  would  rise  that 
day,  if  they  did  not  carry  out  the  prophylactic 
course  I  had  prescribed,  but  which  nine-tenths 
were  very  sure  not  to  do  because  they  were  feel- 
ing so  well  that  they  thought  it  useless  to  con- 
tinue taking  medicine;  and  I  have  heard  pa- 
tients boast  an  hour  before  the  paroxysm  did 
return  that  they  felt  better  than  they  had  felt  for 
a  month. 

This  is  very  common  in  malarial  fevers  of  all 
types;  and  I  infer  from  it  that  the  cause  of  these 
fevers  produces  first  a  stage  of  stimulation,  by 
irritating  certain  nerve  centers,  followed  by  a 
reaction  in  the  form  of  a  chill  and  fever,  con- 
stituting the  stage  of  depression  or  probably 
better  a  true  neurasthenia.  But  while  learning 
this  I  found  that  nothing  of  the  kind  occurred 
in  yellow  fever  and  that  there  did  not  exist 
the  faintest  or  most  remote  trace  of  relation- 
ship between  it  and  this  class  of  fevers,  or 
any  other  for  that  matter;  but  that  it  was  so  ex- 
clusively sui  generis  that  it  would  never  asso- 
ciate or  co-exist  in  the  system  with  them,  or 
with   any   other   acute    disease.     Thus    I  soon 


P" 


YELLOW   FEVER.  35 


learned  to  differentiate  and  easily  distinguish  it 
from  any  other  fever  or  morbid  condition,  and 
I  have  been  so  fortunate  in  this  regard  as  never 
since  to  have  been  mistaken  in  my  diagnosis. 

God  knows  I  write  this  in  no  spirit  of  vain- 
glory or  boasting;  for  the  consciousness  and 
memory  of  the  many  errors  and  mistakes  of  my 
early  years  are  ever  present  with  me,  and  are 
too  hiimilating  ever  to  permit  me  to  become  vain 
or  puffed  up  by  all  the  knowledge  that  I  can 
acquire  of  this  or  any  other  disease. 

It  has  been  my  duty  on  three  different  occa- 
sions to  be  the  first  to  announce  the  existence 
of  yellow  fever  in  interior  towns,  from  the  fact 
that  the  first  cases  among  the  refugees  incident- 
ally came  under  my  care  and  treatment;  and'in 
every  instance  I  had  the  misfortune  to  be  at  first 
opposed  in  my  diagnosis  and  announcement  by 
the  rest  of  the  resident  profession;  and  in  the  last 
instance  I  was  opposed  not  only  by  resident 
doctors  but  also  by  a  dozen  or  more  physicians 
and  yellow-fever  experts  from  other  towns  And 
cities.  In  the  excitement  and  terror  of  last 
year  (1897)  I  took  a  decided  stand  at  the  begin- 
ning, vehemently  combatting  the  diagnosis  of  the 
official  experts  and  contended  that  only  dengue, 
in  .a  more  serious  and  grave  form  than  usual, 
was  prevailing  not  only  in  this  state  (Texas)  but 
throughout  the  whole  Southwest.  Time,  which 
proves  all  things,  fully  sustained  and  justified 
me  in  my  diagnosis  in  the  three  instances  first 


86  -       YELLOW   FEVER. 

named;  for  a  serious  epidemic  ensued  in  each 
case,  and  a  number  of  valuable  lives  were  lost 
which  would  have  been  saved  by  flight  but  for 
the  number  and  unanimity  of  opinion  of  those 
dissenting  from  my  report  that  it  was  yellow 
fever.  As  regards  the  epidemic  of  last  year  the 
evidence,  at  this  time,  is  overwhelmingly  in  my 
favor  that  not  a  single  case  of  yellow  fever  oc- 
curred in  Texas,  and  is  sufficient  also  to  cause, 
grave  doubts  of  there  having  been  any  true  yel- 
low fever  east  of  the  Mississippi  during  the  same 
period. 

Having  expressed  opinions  of  the  incompati- 
bility of  yellow  fever  with  the  paludal  fevers  and 
all  acute  maladies,  opinions  which  are  diamet- 
rically opposed  to  the  teachings  of  two  of  our 
most  learned  and  distinguished  authors  on  the 
subject,  Drs.  LaRoche  and  Fag^t,  I  deem  it 
incumbent  upon  me,  before  taking  up  the  subject 
of  treatm.ent,  to  give  my  reasons  therefor  and 
the  evidence  upon  which  they  are  based.  But  I 
will  first  say  that  I  "am  inclined  to  think  that  the 
positions  which  these  distinguished  gentlemen 
occupied  in  the  profession  were  too  high  to  allow 
them  time  or  opportunity  to  make  such  close, 
critical  and  scrutinizing  observations  (or  to  follow 
individual  cases  to  their  termination)  as  a 
physician  can  who  occupies  an  humbler  posi- 
tion and  is  not  hampered  by  official  or  public 
duties.  I  think  I  am  justified  in  expressing 
such  an  opinion  from  the  number  of  oversights 


|:  YELLOW  FEVER.  87 

j.  and  mistakes  which    I   have  witnessed  in  phy- 

p  sicians  filling  professorships,    and  whom   I  re- 

f  garded  is  much  my  superiors  in  their  knowledge 

;'  of  this    disease.     In    every   epidemic  of  yellow 

fever,  with  which  I  have  had  experience,  I  have 
i^  witnessed    the    sudden    cessation    of    malarial 

f  fevers  which  had  been  very  rife  just  prior  to  the 

introduction  of  the  exotic  and  major  poison; 
W  and  the  only  cases  of  it  with  which  I  met  during 
f  the  prevalence  of  the  epidemic  were  in  persons 

who  had  been  subject  to  recurring  attacks  of 
the  intermittent  from  every  fourteen  or  twenty- 
one  days,  and  these  persons  were  invariably 
among  the  last  to  be  attacked  by  the  yellow 
fever.  During  such  an  epidemic  I  have  never 
met  with  a  case  of  malarial  fever  occurring 
de  novo  in  a  person  not  previously  subject  to  it, 
except  in  Memphis  in  ISVS. 

Now  I  know  that  I  shall  be  charged  with 
calling  any  and  every  case  of  fever  occurring 
during  an  epidemic,  yellow  fever.  But  correct 
diagnosis  has  been  my  one  special  pride  and  strong 
point  during  all  the  years  of  my  practice;  and  I 
do  not  feel  that  I  have  ever  been  guilty  of  the 
mistake  of  diagnosing  and  calling  a  case  of 
malarial  fever,  yellow  fever,  or  vice  versa;  for  it 
was  between  these  fevers  especially  that  I  had 
an  ambition  to  learn  how  to  make  a  differential 
diagnosis,  and  to  this  end  I  labored  and  strove 
during  all  the  early  years  of  my  professional  life. 
I  willingly  admit  that  the  two  diseases  are'occa- 


$-: 


88  YELLOW   FEVER. 

sionally  seen  prevailing  in  the  same  place  at 
the  same  time;  but  my  observation  has  been 
that  the  paludal  fever  gives  place  gradually  and 
completely  to  the  specific  one,  and  this  spares 
no  one  (except  the  pure-blooded  African)  from 
the  infant  at  the  breast  to  the  aged  pilgrim 
tottering  on  the  verge  of  the  grave.  Hence  I 
think  that  the  distinguished  Professor  Fag^t 
strained  a  point  unsuccessfully  in  attempting  to 
prove  that  the  children  of  Creoles  were  not  liable 
to  yellow  fever,  when  he  endeavored  to  show 
that  the  large  number  of  cases  of  fever  among 
them,  attended  with  hemorrhages  and  black 
vomit,  in  the  epidemic  of  1853,  '58,  '67,  were  not 
yellow  fever,  but  **haematemesic  paludal  fever'' 
which  prevailed  epidemically  those  years  con- 
jointly with  yellow  fever. 

It  is  passing  strange  that  this  peculiar  and 
rare  type  of  malarial  fever,  which  is  only  occa- 
sionally seen  in  sporadic  form,  should  have 
prevailed  epidemically  during  the  severe  yellow- 
ever  epidemics  of  those  years  and  never,  at 
least  to  any  extent,  before  or  since.  I  have 
seen  a  dozen  cases  in  one  season  since,  but  did 
not  regard  this  as  an  epidemic.  It  has  never  fallen 
to  my  lot  to  see  a  case  in  which  beyond  all  doubt 
the  two  diseases  co-existed  in  the  system.  As 
I  have  said  before  all  persons  subject  to  re- 
curring attacks  of  intermittent  fever  were  among 
the  last  to  succumb  to  yellow  fever,  and  then 
not    until    the   intermittent  had  been    arrested. 


YELLOW   FEVER.  89 

And  my  observation  has  invariably  been  that  in 
all  cases  where  the  paludal  poison  had  posses- 
sion, by  preemption  or  priority  of  entrance,  the 
yellow  fever  poison  either  could  not  or  would 
not  enter  until  the  former  had  been  dislodged 
or  had  thoroughly  I  evacuated  the  premises. 

Let  me  illustrate  my  idea  further  by  a  few 
cases.  In  Calvert,  Texas,  in  1873,  I  treated  a 
young  man  in  July,  August  and  September  for  a 
recurring  intermittent  and  failed  to  arrest  its 
regular  return  every  twenty-one  days,  because 
he  was  too  busy  to  take  the  prophylactic  rem- 
edies I  had  prescribed.  In  October  my  friend, 
the  late  Dr.  Greenville  Dowell,  who  was  daily 
visiting  myself  and  family  during  our  attack  of 
yellow  fever,  was  called  to  see  this  same  young 
man.  His  favorite  remedies  for  yellow  fever, 
calomel  and  quinine,  quickly  cured  him;  and  the 
good  Doctor,  in  his  efforts  to  persuade  me  to 
take  the  same,  related  this  among  other  cases  to 
show  the  great  success  of  his  treatment.  Now 
the  truth  was,  this  was  simply  the  fourth  recur- 
rence of  his  intermittent  fever  without  any  sign 
of  yellow  fever  at  all;  for  late  in  November, 
ten  days  after  safely  passing  the  time  for  the 
fifth  period,  when  he  was  congratulating  himself 
on  at  last  being  rid  of  his  chills,  he  was  seized 
with  a  violent  attack  of  yellow  fever  accompanied 
by  black  vomit,  and  died  in  a  few  days. 

I  met  with  a  dozen  or  more  just  such  cases  in 
Memphis  in  1878.     I  made  it  my  special  duty  to 


90  YELLOW   FEVER. 

watch  them  all  closely;  and  while  three  of  them  en- 
tirely escaped  yellow  fever,  the  rest  were  attacked 
during  November;  but  not  in  a  single  instance 
did  the  yellow  fever  supervene  until  it  had  been 
demonstrated  that  the  intermittent  had  been 
arrested,  which  was  known  by  the  patient's 
safely  passing  an  expected  period  ten  days. 

My  driver,  a  young  man  aged  22,  was  a  not- 
able case.  He  regularly  had  an  attack  of  inter- 
mittent fever  every  fourteen  days  during  August, 
September  and  October;  refusing  to  take  any- 
thing to  break  up  or  prevent  the  return  of  the 
paroxysms  because  he  had  heard  that  a  person 
could  not  have  yellow  fever  as  long  as  he  had 
intermittent.  So  he  lost  two  or  three  days  every 
two  weeks,  but  he  would  get  a  younger  brother 
to  drive  for  me  until  he  was  able  to  resume  his 
place.  I  treated  his  father  and  mother  and 
seven  brothers  and  sisters,  sick  with  yellow 
fever  during  September  and  October,  without 
the  loss  of  one.  He  escaped  the  intermittent 
paroxysm  due  November  first,  and  on  the  tenth 
of  that  month  he  was  seized  with  a  violent  attack 
of  yellow  fever  and  came  near  dying;  but  he 
finally  recovered  after  six  weeks'  confinemient  to 
the  bed  where  I  left  him,  the  epidemic  being 
over. 

But  the  saddest  case  remains  to  be  told.  On 
October  seventeenth,  while  eating  supper  at  the 
Peabody  Hotel  where  the  volunteers  were  all 
lodged  by  the  Howard  Association,  I  received  a 


YELLOW   FEVER.  91 

message  from  a  very  prominent  volunteer  phy- 
sician, from  one  of  the  Northern  States,  request- 
ing me  to  come  to  his  room  as  soon  as  I  had 
finished  supper.  I  knew  he  was  subject  to 
recurring  attacks  of  intermittent  fever;  and  as 
he  had  informed  me  that  he  had  yellow  fever  in 
■  Mobile  more  than  twenty  years  before,  I  sup- 
posed there  was  nothing  serious  the  matter. 
Upon  entering  his  room  I  found  him  sitting  on 
the  side  of  the  bed  and  clad  in  his  underclothes. 
As  he  had  a  rather  dejected  or  apathetic  expres- 
sion of  countenance,  I  greeted-  him  pleasantly 
with,  "Well,  Doctor,  are  you  having  another 
one  of  those  annoying  paroxysms  of  ma- 
larial fevers?"  "Yes,"  he  replied,  ''but  a  very 
anomalous  one;  for  it  postponed  a  week, 
and  I  was  feeling  better  than  usual,  when 
to  my  surprise  at  three  o'clock  yesterday  morn- 
ing I  had  a  very  severe  chill  followed  by  a  fever 
lasting  till  noon  today.  I  took  three  compound 
cathartic  pills  last  night  and  have  taken  about 
forty  grains  of  quinine  in  ten-grain  doses  today, 
but  I  am  feeling  very  queer  tonight."  I  was 
feeling  his  pulse  while  he  was  saying  this,  and 
watching  his  countenance.  To  my  intense  sur- 
prise, I  felt  the  characteristic  yellow-fever  pulse 
and  saw  plainly  depicted  the  unmistakable  facies 
of  that  terrible  disease,  exhibiting  what  I  con- 
sider its  fatal  aspect. 

With  watch  in  hand  I  said:     "Doctor,  I  have 
an  engagement  to  meet   our   medical  director, 


92  YELLOW   FEVER. 

Dr.  Mitchell,  in  five  minutes,  which  I  had  for- 
gotten till  this  moment.  If  you  will  excuse  me 
I  will  run  down  to  headquarters,  sec  him  and 
then  ask  him  to  come  back  with  me  to  see  you. 
r  will  not  be  gone  ten  minutes.  Let  me  suggest 
that  you  lie  down  and  cover  up  until  I  return." 
The  Howard  Medical  Headquarters  were  only 
half  a  block  distant.  I  found  Dr.  Mitchell,  and 
said:  *'One  of  your  volunteer  physicians  is 
quite  ill  at  The  Peabody,  and  I  want  you  to  go 
with  me  at  once  to  see  him."  On  the  way  he 
asked  a  number  of  questions;  but  I  said,  "Wait 
until  you  see  him,  for  I  want  your  opinion  un- 
biased by  mine." 

Again  the  patient  was  found  sitting  upon  the 
side  of  the  bed.  I  saw  Dr.  Mitchell's  eyes  dilate 
as  they  fell  upon  him;  and  greeting  him  kindly 
by  name,  he  aoked  abruptly:  ''Dr.  K.,  when  did 
your  kidneys  act?  How  much  urine  have  you 
passed  today?"  The  question  seemed  to  con- 
fuse and  irritate  the  Doctor,  and  he  replied  a 
little  petulently:  "Now  Doctor  Mitchell,  don't 
think  I  have  yellow  fever,  for  I  had  it  twenty 
odd  years  ago  in  Mobile,  Alabama;  but  really,  I 
do  not  remember  having  passed  any  urine  today, 
or  since  yesterday  afternoon  for  that  matter." 
"Will  you  please  allow  me  to  try  the  cathe- 
ter?" asked  Dr.  M. ;  consent  being  readily  given 
the  instrument  was  quickly  introduced  but  only 
half  an  ounce  of  urine  was  obtained.  With- 
drawing and  replacing  the  instrument  in  its  case 


YELLOW   FEVER.  93 

and  feeling  his  pulse,  Dr.  Mitchell  arose  saying: 
*'Well,  Doctor,  you  do  not  need  anything  tonight 
except  a  diuretic  mixture  and  a  good  nurse 
to  stay  with  you,  both  of  which  we  will  send 
you." 

"But  I  do  not  need  a  nurse,"  replied  the  pa- 
pient.  "But,"  said  I,-  "you  may  need  to  send 
for  obe  of  us  during  the  night,  or  to  send  a  mes- 
sage to  some  friend,  so  let  the  nurse  come  and 
stay." 

There  was  no  need  to  ask  Dr.  Mitchell  if  he 
thought  as  I  did  and  saw  what  I  had  seen.  Go- 
ing down  the  stairway  his  only  remarlc  was: 
"How  sad!  Is  it  our  duty  to  inform  that  doomed 
man  that  he  is  dying?"  I  replied  that  my  ex- 
perience was  that  no  good  ever  resulted  from  so 
doing.  Our  unfortunate  confrere  died  between 
three  and  four  o'clock  the  next  morning,  forty- 
eight  hours  from  the  inception  of  the  disease. 

Many  similar  cases  might  be  cited  from  every 
yellow  fever  epidemic  prevailing  in  paludal 
regions;  but  the  foregoing  ought  to  be  amply 
sufficient  to  clearly  illustrate  my  idea  and  posi- 
tion as  to  the  impossibility  of  the  co-existence  of 
the  two  diseases  in  the  same  system. 

During  this  same  Memphis  epidemic,  how- 
ever, I  met  with  certain  peculiar  cases  illustra- 
ting the  fact  that  yellow  fever  can  co-exist  with 
certain  acute  diseases,  although,  as  I  have 
shown,  it  cannot  with  intermittent  fever. 

On  September  twenty-fifth  Dr.    Mitchell  said 


94  YELLOW   FEVER. 

tome:  **I  want  you  to  take  charge  of  Major 
R.,  aged  about  sixty  years,  a  particular  friend  of 
mine,  whose  family,  except  his  oldest  son,  is 
out  of  town.  I  have  been  treating  him  for  sev 
eral  days  for  a  severe  attack  of  facial  erysipelas 
which  began  on  the  side  of  the  nose  and  now 
involves  the  whole  face.  His  face  is  so  cedema- 
ous  that  his  eyes  are  closed,  the  line  of  demarka- 
tion  being  just  above  the  eyebrows.  At  three 
o'clock  this  morning  he  had  a  chill  which  was 
the  beginning  of  an  attack  of  yellow  fever;  and 
as  you  are  hunting  unique  cases  I  turn  him  over 
to  you,'  having  confidence  that  you,  being  a 
stranger  to  him,  can  treat  him  more  successfully 
than  I  can.  I  want  ycu  to  do  your  best."  In 
twenty-four  hours  from  the  inception  of  the  yel- 
low fever  all  signs  of  erysipelas  had  disappeared 
except  a  slight  desqamation,  and  the  case  pra- 
gressed  so  favorably,  in  every  respect,  that  the 
patient  was  able  to  leave  his  bed  and  sit  up  a 
short  time  the  morning  of  the  ninth  day.  That 
evening  the  erysipelas  returned,  beginning  at 
the  line  above  ^the  eyebrows  (the  point  it  had 
reached  when  arrested  by  the  yellow  fever),  and 
continued  its  course  over  the  scalp  down  to  the 
nape  of  the  neck  before  it  could  again  be  ar- 
rested. 

His  son,  a  young  man  of  thirty-two  years,  was 
his  principal  nurse,  and  I  cautioned  him  not  to 
inhale  his  father's  breath  while  handling  him.  On 
the  first  of  October  the  son  exhibited  symptoms 


YELLOW   FEVER.  95 

indicating  that  erysipelas  was  commencing  in  his 
throat.  But  he  had  a  chill  that  night  ushering 
in  an  attack  of  3^ellow  fever,  which  ran  a  course 
very  similar  to  his  father's  case.  At  my  after- 
noon call,  October  ninth,  I  found  him  sitting  up 
at  a  window,  enjoying  the  gentle  Southern 
breeze.  I  told  him  it  was  very  imprudent,  as  I 
thought  he  still  had  to  suffer  with  the  erysipelas 
which  certainly  was  commencing  when  he  was 
taken  with  yellow  fever.  He  went  back  to  bed, 
saying  his  throat  was  feeling  a  little  sore.  At 
nine  that  night  he  had  a  severe  rigor;  but  he 
did  not  send  for  me  till  six  o'clock  the  next 
morning,  and  it  was  eight  o'clock  before  I 
reached  his  bedside.  I  found  him  in  a  horrible 
condition.  He  took  my  tablet  and  wrote:  **For 
God's  sake  give  me  something  to  put  me  out  of 
my  misery."  His  tongue  was  black  and  swol- 
len until  it  protruded  between  his  lips  so  that  he 
could  not  articulate.  I  sent  a  messenger  for 
Dr.  Mitchell,  who  arrived  in  a  short  time,  and 
we  did  all  in  our  power  lo  relieve  him,  but  in 
vain.  He  died  a  horrible  death  at  noon  the  next 
day. 

I  will  cite  one  more  case  to  illustrate  how  gen- 
erally in  an  epidemic  of  that  disease  everything 
s  called  yellow  fever,  not  only  by  ordinary  phy- 
sicians but  also  by  those  occupying  high  posi- 
tions. By  permission  of  my  friend,  Dr.  Green- 
ville Dowell,  who  had  charge  of  the  Market 
Street  Hospital,  and  at  the  patient's  request,  I 


9")  YELLOW   FEVER. 

was  called  to  treat  Dr.  S.  H.  McCormick  of  Sa- 
line City,  Indiana,  who  was  sick  in  the  hospital. 
This  hospital  was  a  four-story  building,  with  a 
capacity  for  accommodating  two  hundred  pa- 
tients, by  crowding  a  little.  Dr.  McCormick 
w^as  in  the  fourth  story  and  was  the  fifteenth  pa- 
tient in  a  rather  small  ward. 

On  the  third  morning  Dr.  Dowell  invited  me 
to  accompany  him  on  his  rounds  through  all  the 
wards  of  the  hospital,  an  invitation  which  I 
gladly  accepted.  He  remarked  as  we  started 
that  ninety  per  cent  of  all  the  patients  who  had 
been  brought  into  that  building  so  far  had  been 
sent  out  through  the  dead  house.  What  a  ter- 
rible report!  But  it  was  explained  by  the  fact 
that  many  were  picked  up  on  the  streets  and 
brought  in  from  elsewhere  in  a  moribund  condi-, 
tion.  The  Doctor's  progress  was  so  rapid  that 
it  was  with  difficulty  that  I  kept  up  with  him, 
and  of  course  could  derive  no  benefit  from  the 
trip.  But  the  Doctor,  notebook  in  hand,  pre- 
scribed for  each  case;  but  as  the  treatment  was 
routine,  that  w-as  not  difficult.  At  last,,  on  the 
third  floor,  in  passing  cot  after  cot,  he  remarked 
as  he  passed  a  certain  one:  "This  man  is  from 
your  town  in  Texas."  Upon  recognizing  him  I 
asked  why  he  was  there.  The  Doctor  replied 
that  he  was  brought  in  that  morning  sick  with 
yellow  fever.  ''But  come  back  here,  Dr.  Dow- 
ell," I  said,  ''this  man  has  had  yellow  fever  in 
a  previous  epidemic  and  cannot  have  it  now." 


YELLOW   FEVER. 


97 


"Oh yes,"  replied  the  doctor,  ''he  has  a  genu- 
ine case. "  ' 

I  sat  down  by  the  cot,  and  taking  hold  of  the 
man's  wrist  found  a  pulse  indicative  of  an  inflam- 
matory fever.  Calling  him  by  name,  I  said: 
"Look  here!  Tell  me  the  truth!  What  has  hap- 
pened to  you?" 

"Well,  Doctor,  in  getting  out  of  the  carriage  a 
few  days  ago,  at  a  funeral,  the  horse  started  sud- 
denly and  I  was  thrown  violently  against  the 
wheel  hurting  my  left  testicle  severely." 

"Yes,  Joe,"  said  I,  "I  heard  that  cart-wheel 
story  in  Philadelphia,  in  my  student  days,  years 
ago.     Let  us  see  the  amount  of  the  damage." 

Examination  revealed  an  intense  orchitis,  the 
cause  of  his  fever;  and  I  said,  "You  had  better 
get  out  of  here,  for  nearly  everyone  who  comes 
indies."  I  lanced  his  testicle  twice  after  he  re- 
turned to  Texas.  He  said  he  never  was  so  re- 
lieved in  his  life  as  when  he  heard  me  say  that 
he  did  not  have  yellow  fever. 

Upon  arriving  in  Memphis,  in  1878,  I  was 
much  astonished  to  find  such  a  virulent  epi- 
demic prevailing;  and  although  familiar  with  it, 
the  odor  was  so  intolerable  at  the  hotel  that  I 
requested  the  clerk  to  give  me  a  room  in  the 
fourth  story.  After  entering  upon  my  duties  in 
the  district  assigned  me,  I  would  dismiss  my 
buggy  in  the  suburbs  at  six  in  the  afternoon, 
spending  the  night  at  the  residence  of  some  im- 
portant patient  who  was  always  glad  to  have  me 


98  YELLOW   FEVER.  - 

remain,  and  would  order  my  driver  to  return  in 
time  to  take  me  to  the  hotel  for  breakfast. 

I  was  also  astonished  to  see  the  number  of 
mexperienced  officers  in  this  terrible  battle — 
young  physicians,  principally  from  the  great 
Northwest,  who  had  never  seen  the  disease  and 
who  were  totally  ignorant  of  its  nature.  It  oc- 
curred to  me  that  this  was  a  splendid  oppor- 
tunity to  obtain  statistics  and  make  certain  ob- 
servations in  regard  to  the  disease,  which  I  had 
long  desired  to  do.  I  therefore  maxie  it  a  point 
to  obtain  the  name,  address  and  time  of  arrival 
in  Memphis  of  every  one  I  saw  wearing  a  How- 
ard Medical  badge.  One  evening  after  supper 
quite  a  number  of  them  gathered  around  me, 
w^hile  I  w^as  entering  data  obtained  that  day,  and 
were  very  curious  to  know  why  I  was  thus  get- 
ting their  names  and  addresses.     I  replied: 

"Young  gentlemen,  I  am  deeply  interested  in 
the  study  of  yellow  fever  of  which  I  know  noth- 
ing, though  I  have  been  seeing  it  at  intervals  for 
twenty-five  years.  I  am  also  much  pained  to  see 
you  manifest  such  careless  indifference  to  the 
great  danger  into  which  you  have  unwittingly 
rushed;  for  let  me  tell  you  that  in  the  fiercest 
battle  of  the  late  war  the  danger  to  the  same" 
number  of  officers  was  never  half  as  great  as 
that  to  which  you  are  all  exposed."  They  laugh- 
ingly replied: 

"Why,  it  is  only  a  malignant  form  of  bilious 
fever,  totally  non-contagious,  and  we  are  going 


I    ..  YELLOW   FEVER.  99 

to  cure  it  with  plenty   of   calomel  and    quinine, 
and  keep  it  off  by  taking  quinine."     To  this  I 
;  said: 

r  **If  one  in  twenty  of  you  escape  an  attack^  I 

will  be  much  surprised";  and  showing  them 
my  book  in  which  I  had  entered  their  names  r  nl 
drawn  lines  for  columns  headed,  -  ''date  of  arri- 
val, date  of  attack,  period  of  incubation,  result, 
i  recovery,  died,"  I  added,  "and  I  very  much  fear 

I  that  many  of  your  names  will  appear  in  the  last 

column." 
I  I  obtained  a  list    of   forty-five,   to   which  Dr. 

j  Mitchell   added    nine   more.     Of   my   forty-five 

1  only  one  escaped   having   this    fever,  one  who 

i  wisely   deserted    and    returned  home  after  that 

night's  talk;  and  thirty  were  buried  in  the  beau- 
j:  tiful  cemetery  of   Elmwood  in   less  than  thirty 

days  from  that  hour.  Many  of  them  requested 
me  to  attend  them,  if  they  should  accidentally 
contract  the  disease;  but  the  confusion  that 
reigned  and  certain  uncontrolable  circumstances 
combined  to  prevent  this,  so  that  I  only  attended 
three,  one  of  whom  being  too  obstinate  to  listen 
to  advice  from  any  one  died  in  the  second  re- 
lapse. The  shortest  period  of  incubation  was 
one  day,  the  longest  twenty-five  days;  and  in 
these  two  instances  also  the  patients,  for  weeks 
previously,  had  suffered  recurring  attacks  of  inter- 
mittent fever.  Noble  band  of  martyrs!  In  their 
anxiety  and  effort  to  relieve  the  distress  and  suf- 
fering   surrounding    them,    they  ignored    their 


loo  YELLOW   FEVER. 

own   danger  and  died  without  a  thought  of  self. 

Upon  the  announcement  of  the  first  cases  in 
July,  1879,  I  was  appointed  inspector  under  the 
National  Board  of  Health  and  ordered  to  Mem- 
phis to  investigate  their  origin.  This  appoint- 
ment was  due,  I  suppose,  to  two  members  of  the 
board,  Doctors  Mitchell  and  Bemiss,  who  well 
knew  my  theory  of  hibernating  germs.  Upon 
arriving  in  Memphis  about  July  twelfth,  I  found 
that  on  the  ninth  three  cases  had  occurred  in 
different  parts  of  the  city  a  mile  apart  and  ap- 
parently having  no  connection  with  each  other. 
There  had  been  a  celebration  of  the  Fourth  on 
the  bluff,  at  which  there  was  an  immense  gather- 
ing, and  the  day  was  intensely  sultry.  I  found 
that  certain  parties  had  ordered  two  box-cars  of 
bananas  from  New  Orleans  especially  for  this 
celebration;  and  after  three  weeks  of  patient  in- 
vestigation and  inquiry,  I  established  the  fact  ^ 
that  the  three  cases  first  reported  were  in  per- 
sons connected  with  the  handling  and  sale  of 
those  bananas. 

Knowing  from  past  observation  that  this  par- 
ticular fruit  was  a  splendid  fomite  for  the  trans- 
portation of  yellow-fever  germs,  I  obtained  from 
the  records  of  the  railroad  office  the  numbers  of 
the  box  cars  in  which  this  fruit  was  brought  to 
Memphis  and  the  date  of  their  arrival.  Armed 
with  this  information,  I  went  to  New  Orleans; 
and  going  carefully  over  the  Custom  House  rec- 
ords of  the  arrival  of  every  vessel  from  the  first 


YELLOW  FEVER.  loi 

of  May  to  the  thirty-first  of  July,  I  selected  the 
steamer  E.  B.  Ward,  Jr.,  which  had  arrived 
from  Blue  Fields,  June  twenty-seventh,  as  the 
vessel  most  likely  to  have  brought  in  those  ba- 
nanas which  I  believed  to  be  the  cause  of  the 
outbreak. 

Further  investigation  developed  the  fact  that 
the  two  box  cars  in  question  had  been  run 
down  alongside  of  the  Ward, June  twenty-eighth, 
and  loaded  directly  from  her  hold  with  bananas 
for  Memphis.  This  steamer  belonged  to  that 
wealthy  Italian  who  a  few  years  afterwards,  with 
a  number  of  others,  was  shot  to  death  by  a  mob 
in  the  jail  of  New  Orleans,  and  was  one  of  the 
line  of  vessels  running  to  Blue  Fields  under 
special  privileges,  not  being  inspected  or  de- 
tained at  quarantine. 

When  I  announced,  as  the  result  of  my  inves- 
tigations, that  this  vessel  had  brought  the  germs 
of  yellow  fever  that  was  then  prevailing  in  New 
Orleans  and  Memphis,  a  vigorous  protest  was 
raised;  and  a  number  of  prominent  business 
men  and  managing  officials  of  transportation 
lines  said: 

"Doctor,  it  will  never  do  to  make  such  a  re- 
port. Why,  not  a  single  case  of  yellow  fever 
has  occurred  on  that  vessel  this  season!" 

"And  a  good  reason  why  there  has  not,"  said 
I,  "for  her  astute  owners  have  selected  her  crew 
with  that  object  especially  in  view;  all  are  well- 
known  immunes."    . 


I02  YELLOW   FEVER. 

Two  of  the  crew  informed  me  that  the  steamer 
called  at  Havana  on  the  return  trip  of  that  date; 
but  from  lack  of  authority  and  opportunity  I 
failed  to  obtain  their  sw^orn  statements  to  that 
effect.  So  once  more  commercial  and  pecuniary 
interests  were  powerful  enough  to  suppress 
truth  in  reference  to  this  terrible  scourge. 

And  now  what  shall  I  say  upon  the  subject 
of  treatment,  which  really  does  not  come  within 
the  purview  of  this  work  and  the  discussion:  of 
which  properly  belongs  to  those  who  are  still  in 
active  practice  and  yearly  seeing  the  disease? 
Although  I  have  been  deeply  interested  and 
have  spent  much  time  in  the  study  and  investi- 
gation of  the  origin,  cause  and  nature  of  yellow 
fever,  still  I  have  never  lost  sight  of  and  have 
tried  to  keep  pace  with  all  the  novelties  and  sup- 
posed modern  improvements  in  its  treatment. 
Nor  have  I  found  it  a  difficult  task;  for,  after 
an  impartial  review  of  the  subject  and  a  study  of 
the  different  methods  of  treatment  that  have 
prevailed  from  its  earliest  history  to  the  present 
time,  I  must  candidly  say  that  I  fail  to  see 
wherein  classic  medicine  has  made  any  advance 
or  improvement  upon  the  treatment  of  Rush  and 
Physick,  barring  their  lancets,  or  can  boast  of 
any  better  success;  w^hile  homeopaths,  expect- 
ants and  other  irregulars  have  jogged  along, 
pari  passu,  claiming  equal  if  not  better  success 
and  that  too  not  without  good  show  of  reason 
and  statistics. 


YELLOW   FEVEK.  103 

At  that  last  meeting  of  the  Howard  Medical 
Association  of  Memphis,  reports  were  made  by 
different  members  of  the  corps  of  the  individual 
methods  of  treatment,  statistics  of  success,  etc., 
during  that  terrible  epidemic  of  I8ld  then  rap- 
idly drawing  to  a  close.  While  the  treatment 
of  no  two  of  them  was  exactly  alike,  yet  when 
analyzed  the  differences  were  found  to  be  im- 
material; for  calomel  and  quinine  seemed  to  in- 
itiate and  calomel  and  quinine  to  close  it.  That 
was  active  medication  indeed;  for  death  fre- 
quently dropped  the  curtain  on  the  closing  scene 
unknown  to  the  physician,  as  I  accidently  learned. 
Among  those  reporting  were  some  on  my  list 
who  had  passed  through  an  attack  successfully, 
and  were  rather  exultant  over  their  method  of 
curing  the  disease  with  teaspoonful  doses  (as 
they  expressed  it )  of  quinine.  But  unfortunately 
they  had  not  learned  the  course  of  the 
disease,  even  from  their  personal  experi- 
ences, and  supposed  that  the  subsidence  of 
the  fever  with  the  deceptive  calm  at  the  end  of 
seventy-two  hours  was  the  result  of  their  large 
doses  of  quinine  and  the  end  of  the  disease;  and 
on  account  of  the  number  of  calls  which  they 
had  to  attend  they  dismissed  sucH  cases  from 
their  minds,  thinking  that  they  were  really  con- 
valescent. 

After  our  active  labors  were  over,  our  Medi- 
cal Director  requested  me  to  make  a  careful  can- 
vass of  several  of  the  districts  for  the  purpose  of 


104  YELLOW   FEVER. 

obtaining  certain  statistical  data  as  well  as  to 
learn  all  the  facts  surrounding  the  death  of  sev- 
eral of  the  volunteers  on  my  list,  who  had  died 
in  private  houses,  that  we  might  be  enabled  to 
answer  intelligently  letters  of  inquiry  from  their 
families.  It  was  while  I  was  engaged  in  this  duty 
that  I  learned  the  facts  just  stated;  and  I  was 
pained  to  hear,  in  many  houses,  not  loud  but 
deep  and  bitter  curses  against  the  physicians  for 
giving  such  large  doses  of  quinine  to  their  loved 
ones  and  then  heartlessly,  as  they  supposed, 
neglecting  them.  I  also  learned  that,  still  la- 
boring under  the  erroneous  idea  of  a  relation- 
ship between  malarial  and  yellow  fever,  they  had 
advised  a  continuation  of  these  doses  three 
times  a  day  after  the  subsidence  of  the  fever  to 
prevent  its  return!  So  in  my  last  paper  before 
the  Association  I  thought  there  could  be  no  im- 
propriety, considering  the  difference  in  our  ages, 
for  me  to  say:  **If  those  gentlemen  who  have 
been  advocating  the  use  of  quinine  in  such  large 
doses  would  take  the  trouble  to  go  over  their 
part  of  the  battle  ground  again  with  a  list  in 
hand  of  the  patients  treated,  they  would  be 
astonished  to  find  the  number  of  those  they  had 
marked  convalescent  who  had  since  died." 

Like  all  young  graduates  I  had  reverence  and 
love  for  my  Alma  Mater,  and  implicit  confidence 
in  the  wisdom,  knowledge  and  infallibility  of 
those  whose  names  were  appended  to  my  di- 
ploma.  But  this  glamour  quickly  wore  off  under 


YELLOW   FEVER.  105 

the  effects  of  personal  observation  and  stern  bed- 
side experience;  and  I  must  confess  that  I  was 
not  long  faithful  to  the  magister  ^/.^c//,- especially 
in  reference  to  this  disease.  I  soon  found  that 
personal  observation  and  experience  are  the  only- 
masters  who  never  deceive  and  upon  whose  dicta 
we  can  always  depend.  Under  the  guidance  of 
these  teachers  it  will  not  take  the  observer  long 
to  find  out  that  yellow  fever  will  run  its  pecu- 
liar but  regular  course  unaffected,  whether  medi- 
cine has  been  administered  or  not.  Upon  learn- 
ing this  fact,  the  question  immediately  presented 
itself:  What  then  is  the  indication  for  the  ten 
to  twenty  grains  of  calomel  and  twenty  grains 
of  quinine  with  which  I  was  taught  to  begin  the 
treatment? 

Further  experience  and  observation  taught  me 
that  the  condition  produced  in  the  system  by  the 
effects  of  the  poison  was  one  not  of  sthenia  or 
inflammation,  as  believed  and  taught  by  the 
great  Doctor  Rush  (which  belief  caused  him  to 
use  the  lancet), but  one  of  asthenia,  general  de- 
bility and  lowered  vitality.  Hence  not  only  the, 
utter  uselessness  but  the  extreme  harmfulness 
of  these  two  potent  remedies  which  I  had  used 
so  freely,  for  their  effects  tended  only  to  increase 
the  existing  debility  and  still  further  to  lower  vital 
energy.  I  saw  that  medicine  had  discovered  no 
antidote;  nor  had  it  instituted  any  method  of 
treatment  that  could  modify,  shorten  or  abort 
this  terrible  disease.     And  while  I  regarded  ex- 


io6  YELLOW   FEVER. 

pectancy  as  pusillanimous  in  the  physician  pro- 
fessing ability  to  combat  disease,  yet  in  the  light 
of  my  experience  so  far  I  considered  it  prefer- 
able to  a  course  of  active  medication  which,  I 
had  found  to  do  more  harm  than  good. 

I  further  learned  from  observation  and  actual 
bedside  experience  that  a  large  per  cent  of  the 
whole  number  of  cases  in  an  epidemic  would 
recover  without  any  medication  whatever,  if  they 
were  controlled  properly,  nursed  carefully  and 
kept  from  exposing  themselves  or  committing 
any  great  imprudence;  while  on  the  other  hand 
I  found  that  a  smaller  per  cent,  although  con- 
stituting a  fearful  rate  of  mortality  (say  twenty- 
five  per  cent  of  the  whole  number),  would  die 
in  spite  of  all  that  medical  art  had  learned  to  do 
for  them.  I  believed  it  to  be  the  obseryant  phy- 
sician's first  duty,  and  not  a  difficult  one  either, 
to  learn  in  every  epidemic  to  distinguish  quickly 
between  those  non-fatal  and  fatal  cases,  so  that 
he  might  avoid  increasing  the  rate  of  mortality 
by  too  much  officiousness  and  over-medication 
in  cases  that  would  naturally  recover — faults  un- 
fortunately too  common  in  young  physicians 
during  their  first  experience  with  this  disease. 
I  do  not  hesitate  to  admit  that  such  was  the  case 
with  myself;  and  as  I  have  been  a  close  observer 
during  my  whole  professional  life  I  have  seen  the, 
same  faults  in  others. 

Of  the  one  hundred  and  eleven  volunteers  on 
the   Howard  roll  at    Memphis,    in    1878,    how 


YELLOW   PEVER.  107 

many  could  claim  to  be  cool,  close,  critical  ob- 
servers; especially  in  those  first  hours  of  con- 
'  fusion  and  terror?  Less  than  fifty  of  them  had 
ever  seen  the  disease  before;  and  the  impres- 
sion made  upon  me,  as  I  v^atched  them  start 
eagerly  for  the  districts  assigned  them  by  our 
Director  General,  v^as  that  there  was  a  braver 
set  of  men  than  any  that  ever  charged  a  battery 
upon  the  most  fiercely  contested  battle  field  in 
the  world's  history.  Ay  !  braver  than  Tenny- 
son's **six  hundred"  as  they  rode,  on  that  mem- 
orable occasion  of  folly,  "into  the  jaws  of  death. " 
A  poet  laureate  sang  their  brave  but  useless 
deeds,  and  a  grateful  nation  immortalized  them 
in  brass  and  marble;  but  the  nobler  deeds  of 
these  unselfish  heroes  have  never  been  sung.  Day 
after  day  and  week  after  week  they-  unfalter- 
ingly met  and  battled  with  that  unseen  foe, 
passing  through  scenes  in  comparison  with 
which  the  most  hideous  of  battles  pale  into  utter 
insignificance.  War  furnishes  scenes  of  mangled 
men  and  animals  only,  while  those  resulting 
from  the  murderous  work  of  this  King  of  Ter- 
rors often  included  whole  families  —  father,  mother 
and  children  (four,  five,  six,  and  seven)  all  dead 
in  one  room,  and  lying  in  every  conceivable 
posture.  In  one  instance  a  tender  babe  was  the 
only  one  found  alive,  and  it  was  vainly  endeavor- 
ing to  draw  nourishment  from  the  breast  of  its 
mother  lying  dead  upon  the  floor;  in  another, 
the   dead  babe   was  found  with  its  little  gums 


io8  YELLOW   FEVER. 

clinched  around  the  nipple  of  the  left  breast  of 
its  mother  who  was  sitting  stiff,  stark  dead  in  a 
chair. 

Such  were  some  of  the  scenes  which  met  the 
eyes  of  many  of  these  physicians  in  their  first 
rounds;  and  although  some  of  the  few  survivors 
said  to  me  that  they  felt  their  hearts  blanch  as 
they  had  never  done  when  in  the  deadly  breach  of 
battle  through  which  they  had  passed,  blanch 
with  an  undefinablefear  or  momentary  dread  that 
certain  annihilation  awaited  them  as  well  as  the 
doomed  city,  yet  they  neither  faltered  nor  grew 
weary  of  their  self-imposed  tasks  but  were  un- 
tiring in  their  efforts  to  stay  the  ravages  of  the 
plague.  In  fact,  after  the  slight  shock  of  the 
first  reconter  had  passed  they  were  seized  with  a 
fascination  for  this  new,  strange  and  hidden  foe 
that  they  had  volunteered  to  fight;  and  forgetting 
self,  like  the  bird  charmed  by  the  rattle  snake, 
they  labored  and  fell  (as  many  as  six  in  one 
day)  at  their  posts  of  duty  till  the  rate  of  mor- 
tality among  the  non-immune  volunteer  phy- 
sicians in  Memphis  reached  sixty-six  and  two- 
thirds  per  cent!  Two-thirds  of  that  noble  band 
of  volunteers  died  on  the  doctors'  battle  field, 
under  circumstances  which  should  entitle  them  to 
wear  the  crown  of  martyrs  as  well  as  heroes. 
"Greater  love  hath  no  man  than  this,  that  he  lay 
down  his  life  for  his  friend." 

These  facts  first  attracted  my  attention  and 
set  me  to  thinking   of  this  peculiar  scourge  as  a 


YELLOW   FEVER.  109 

Nemesis,  an  agent  of  retributive  justice  for,  the 
punishment  of  a  great  sin  which  for  commercial 
and  pecuniary  gain  had  been  jointly  carried  on, 
for'  nearly  two  centuries,  by  all  the  civilized 
and  Christianized  nations  of  the  earth,  as  a 
legitimate  traffic  (God  save  the  mark)  against 
the  most  benighted  and  ignorant  race  on  the 
globe.  Notwithstanding  the  eloquent  sermon 
preached  by  Rev.  H.  C.  Morrison,  at  the 
Broadway  M.  E.  Church,  South  Louisville, 
Kentucky,  Sunday,  October  18,  1878,  in  which 
he  took  the  position  and  endeavored  to 
prove  that  yellow  fever  could  not  be  in  any 
sense  a  scourge  or  punishment  for  a  sin 
which  the  Southern  people  could  be  held  as 
guilty,  I  still  held  to  my  idea.  But  the  rev- 
erend gentleman  was  plainly  ignorant  of  the 
true  history  of  its  origin  and  especially  of  its 
intimate  and  constant  connection  with  that  ne- 
farious traffic,  the  old  African  slave  trade,  all 
of  which  has  been  detailed  in  the  preceding 
pages. 

Now,  to  finish  the  subject  of  treatment : 
Having  discarded  the  orthodox  method  I  learned 
in  the  halls  of  classic  medicine,  I  adopted  the 
simplest  method  possible,  not  to  be  "expectant" 
though  bordering  closely  on  it.  First:  I  cleared 
the  bowels  perfectly,  as  early  as  possible  in  the 
disease,  with  a  dose  of  castor  oil  or  a  large 
enema  of  hot  water,  not  disturbing  them  again  till 
after  the  fever  subsided. .   Second  :      I  kept  the 


% 


no  YELLOW   FEVER. 

patient  perfectly  quiet  in  a  horizontal  position, 
never  allowing  him  to  rise  up  even  for  a  drink 
of  water,  nor  to  see  any  one  except  his  physician 
and  nurses;  and  to  be  perfectly  on  the  safe  side 
this  was  kept  up  religiously  for  eight  or  nine 
days  (this  is  not  absolutely  necessary  in  all  mild  ' 
cases).  Had  this  been  done  in  Memphis  many 
valuable  lives  would  have  been  saved. 

Let  me  mention  three  notable   cases  to  show, 
how  easily  and  by  what  a  little  thing,  in  this  dis-     '    :  J 
ease,    the   scale  is    turned    against  the  patient.  'i'-- 

When  Mr.  R.  A.  Thompson,  the  postmaster,  was 
stricken,  his  friend,  Herbert  Landrum,  the 
quick,  witty,  sparkling,  and  bright  city  editor  of 
T/ie  Avalanche,  took  him  to  the  home  of  his 
father,  the  Reverend  Doctor  Landrum,  pastor 
of  the  Gentral  Baptist  Church,  and  tenderly 
nursed  and  cared  for  him.  On  the  third  day, 
the  day  of  the  treacherous,  deceptive  calm,  he 
was  free  from  fever  and  thought  to  be  convales- 
cent. That  morning  he  changed  his  pillow  and 
position  from  the  head  to  the  foot  of  the  bed, 
contrary  to  the  advice  of  his  physician.  Dr. 
Mitchell,  made  himself  comfortable  and  read  the 
morning  papers  while  he  leisurely  partook  of  , 
some  tea  and  toast.  In  sixteen  hours  he  was 
dead. 

His  friend,  Herbert  Landrum,  was  taken 
down  in  a  few  days  with  a  mild  attack;  and 
although  this  example  of  the  terrible  effects  of  a 
little  imprudence  was  fresh  in  his  memory   he 


YELLOW   FEVER.  iii 

got  up  on  the  fourth  day  and  went  to  his  office 
to  answer  a  few  letters.  In  less  than  forty- 
eight  hours  he  too  was  dead. 

Mr.  Catron,  a  very  close  friend  of  both, 
nursed  and  helped  to  bury  his  two  friends;  he 
was  mildly  attacked  in  a  few  days,  committed  a 
little  imprudence  after  it  was  thought  that  he 
was  convalescent,  and  soon  followed  them  to 
the  cemetery. 

It  will  readily  be  seen  from  these  cases  that 
good  nursing  and  prudently  remaining  in  bed  a 
sufficient  time  is  worth  more  than  all  the  medi- 
cine that  can  be  given;  and  I  mention  them  as  a 
warning,  hoping  that  they  will  be  the  means  of 
saving  valuable  lives  in  the  future. 

Pirst:  Keep  the  head  cool  by  bathing  it  with  the 
old  French^ 'Eau  Sedative'''  and  the  feet  warm  by 
applying  bottles  of  hot  water  to  them.  If  the 
skin  is  hot  and  dry  during  the  fever  direct  the 
nurse  to  sponge  the  patient  under  cover  every 
two  hours  with  tepid  water  and  whiskey,  wiping 
thoroughly  dry  each  time;  but  if  the  skin  is 
moist  during  the  febrile  stage  this  sponging  will 
be  unnecessary.  If  there  is  much  pain  in  the 
back  or  the  head,  apply  to  the  spinal  column  a 
flannel  strip  saturated  with  spirits  of  turpentine* 
put  a  dry  cloth  over  this,  and  for  ten  or  fifteen 
minutes  gently  rub  a  flat  iron,  as  warm  as  can 
be  comfortably  borne,  up  and  down  the  spinal 
column.  This  is  the  most  grateful  thing  you 
can    do   for   your     patient   and    will   not    only 


112  YELLOW   FEVER.       \ 

relieve  the  pains  but  at  the  same  time  will  cause 
the  whole  body  to  perspire  gently. 

In  the  olden  time  I  frequently  applied  six  or 
eight  cups  along  the  spinal  column,  wet  or  dry  - 
depending  upon  the  condition  of  the  patient; 
and  I  will  add  just  here  in  regard  Jo  this  old 
procedure,  which  seems  to  have  been  entirely 
discarded  of  late  years  because  there  is  a  little  /' 
trouble  connected  with  it,  that  when  there  is  in- 
tolerable nausea  or  incoercible  vomiting  in  yel- 
jow  fever  or  any  other  malady  wet  cups  applied 
freely  over  the  ganglia  of  the  celiac  plexus 
and  the  oesophageal  branches  of  the  pneumo- 
gastric,  from  whence  nerves  are  distributed  over 
the  stomach  and  other  abdominal  organs,  will 
relieve  these  intolerably  miserable  and  some- 
times dangerous  conditions  more  promptly  j 
and  effectually  than  any  internal  or  other 
external  remedy.  Allow  the  patient  all  the 
cracked  ice  he  desires;  use  diluents  freely,  such        -  -j 

as  teas  made  of  watermelon  seed    or  flax  seed 

and  flavored  with  fresh  lemon  juice,  hot  or  cold 
to  suit  the  patient's  taste;  but  be  careful  never  =" 

to  offend  the  stomach   by  forcing  upon  it  any-  ; 

thing  that  it  dislikes.  .  ~i 

No  arterial  sedatives  or  other  febrifuges  are 
required  or  are  even  permissible;  for  the  first 
and  principal  effect  of  the  poison  is  upon  the  ^ 

heart  c^nd  the  blood,  and  the  pulsations  are  too        ^^^^ 
rapidly   diminished    from    this   effect   to    allow  i 

agents  to  be  used  that  will  increase  it.   From  the 


YELLOW   FEVER.     _      _  113 


inception  of  the  disease  strychnine  and  digitalin, 
in  doses  of  half  a  milligram  (gr.  1-134)  each, 
should  be  given  every  hour  to  maintain  nervo- 
vital  energy  and  to  sustain  the  heart's  action. 

Tlie  foregoing  was  my  first  departure  from  the 
teachings  of  the  Masters,  if  departure  it  may  be 
called.  I  have  yet  to  find  anything  that  does 
not  belong  to  regular  or  classic  medicine,  or  to 
find  a  court  for  the  final  decision  of  disagree- 
ments in  matters  of  this  kind.  If  this  were  not 
so  there  would  have  been  no  necessity  of  Pope's 
asking:  *'Who  shall  decide  where  doctors  dis- 
agree?" But  later,  learning  of  M.  Polli's  dis- 
coveries in  regard  to  the  sulphites  and  bisul- 
phites and  their  uses  in  medicine  and  especially 
in  zymotic  diseases,  and  being  encouraged  by 
my  use  of  them  in  variola,  rubeola  and  chronic 
paludal  fevers,  I  determined  to  try  them  in  yel- 
low fever,  especially  the  hypo-sulphite  of  soda 
which  I  knew  would  do  no  harm  even  if  it  ac- 
complished no  good. 

Now  I  went  to  Memphis  to  do  all  tlie  good  I 
could  for  that  sorely  afflicted  people,  but  also 
for  the  purpose  of  making  a  special  study  of  cer- 
tain points  in  the  disease  which  I  knew  I  could 
not  do  if  I  were  over-burdened  with  patients. 
At  my  first  meeting  with  the  Howard  Medical 
Society,  which  met  at  nine  o'clock  every  night 
with  Doctor  Mitchell  in  the  chair,  to  listen  to 
the  daily  reports  from  this  army  of  one  hundred 
and  eleven  volunteers,  I  heard  some  of  my  new 


114  YELLOW   FEVER. 

friends,  whose  names  I  had  been  taking  down 
that  very  day,  report  having  attended  seventy- 
five  to  one  hundred  cases.  I  thought  it  was  my 
time  to  turn  pale,  as  I  had  only  twenty  to  re- 
port; and  I  knew  I  was  not  physically  able  to 
see  and  treat  such  a  number  of  cases,  scattered 
as  they  were  over  the  district — ^old  Fort  Picker- 
ing and  South  Memphis — to  which  I  had  been  as- 
signed the  day  before. 

I  therefore  inquired  what  they  did  for  such  a 
number  of  patients.  "Oh,  we  took~  down  their 
names  and  addresses,  with  street  and  number, 
to  report  at  this  meeting."  I  replied  that  I 
thought  that  that  was  the  duty  of  the  Howard 
visitors,  of  whom  the  Association  had  quite  a 
number  employed,  as  well  as  to  see  that  they 
(the  sick)  obtained  their  medicines  promptly; 
but  that  'I  found  that  the  first  prescription  I 
had  made  the  morning  before  had  not  been  filled 
until  that  evening  on  account  of  the  rush  and 
the  number  ahead  of  it.  '  I  said  I  thought  we 
had  better  all  go  home  for  the  good  we  were 
doing,  unless  Dr.  Mitchell  would  pernxit  us 
to  carry  what  few  medicines  we  needed  and 
dispense  them  ourselves;  for  there  were  not 
prescription  clerks  enough  in  the  city  to  dispense 
one  hundred  of  the  prescriptions  made  daily. 
Moreover,  my  plan  would  mean  a  great  saving 
of  expense  to  the  Association;  for  the  prescrip- 
tion which  I  had  referred  to  (sodium  hyposul- 
phite,    one-half    ounce;    syrup    of  orange,   one 


YELLOW   FEVER.  115 

ounce;  water,  four  ounces)  was  charged  to  the 
Association  at  the  very  moderate  (?)  price  of 
two  dollars,  and  was  received  by  the  patient  too 
late  to  be  of  any  particular  benefit.  Dr. 
Mitchell  said  the  suggestion  was  a  good  one; 
and  from  that  time  on  the  physicians  carried  the 
necessary  medicines  the  Association  having  ob- 
tained possession  of  a  wholesale  drug  store  that 
was  closed  and  put  in  volunteer  clerks  who  sup- 
plied us  with  whatever  we  needed. 

I  said  moreover  that  I  intended  to  see  each 
of  my  patients  twice  a  day,  and  therefore  could 
not  add  a  greater  number  of  new  cases  daily 
than  I  discharged  old  ones.  I  treated  about 
two  hundred  and  forty  patients  in  Memphis,  of 
whom  about  thirty  were  malarial  intermittents 
to  whom  I  gave  but  little  attention;  but  I 
selected  one  hundred  typical  cases  of  yellow 
fever,  of  which  I  kept  a  regular  daily  record  of 
the  pulse,  temperature,  tongue,  bowels,  urine, 
respiration,  appetite  and  sleep.  Of  these  I 
I  treated  fifty  with  sodium  hyposulphite  as  the 
dominant  medicament  and  the  other  fifty  with 
sodium  sulphocarbolate,  giving  these  medicines 
in  doses  of  twenty  grains  every  two  or  three 
hours;  and  in  cases  where  adynamia  predom- 
inated I  also  gave  ammonium  phosphate  in  the 
same  dose,  and  in  extreme  cases  I  gave  ammo- 
nium carbonates  in  doses  of  five  to  ten  grains. 

Whether  the  treatment  pursued  in  these  cases 
had  any  beneficial  effect  I  am  unable  to  say;  and 


ii6  YELLOW   FEVER. 

although  there  were  only  twelve  fatal  cases 
among  them,  a  reasonably  small  death  rate,  yet 
I  am  so  skeptical  about  any  good  ever  having 
been  accomplished  in  the  disease  by  any  course 
of  treatment  with  the  old  galenical  preparations 
that  this  question  arises  in  my  mind:  Would  not 
the  eighty-eight  have  recovered  anyhow,  if  Ihad 
not  seen  them  or  if  not  a  single  dose  of  medi- 
cine had  been  administered  to  thern,  provided 
they  had  been  kept  in  bed  and  properly  nursed. 
I  had  not  then  learned  the  method  of  '<Mod- 
ern  or  Improved  Allopathy,"  taught  by  the 
celebrated  professor  of  Ghent,  Dr.  Adolph 
Burggraeve,  although  it  had  been  known  and" 
used  all  over  Europe  for  ten  years  or  more. 
It  is  strange  that  the  physicians  of  the  United 
States,  who  are  noted  for  being  so  progressive 
and  up-to-date  and  even  in  the  lead  in  many  of 
the  modern  discoveries  and  improvements  in  the 
science  of  medicine  and  who  eagerly  received 
and  tried  Koch's  Tuberculin,  Brown-Sequard's 
Elixir  of  Life,  etc.,  should  have  been  so  slow  to 
investigate  and  try  this  very  simple  yet  truly 
scientific  method  of  exact,  positive  medication 
with  the  alkaloids  and  other  active  principles  of 
plants.  Its  distinguished  author,  who  depre- 
cated its  being  called  a  new  system  of  medicine, 
named  it  ''Dosimetry"  meaning  measured  doses. 
He  and  his  co-laborator,  M.  Charles  Chanteaud 
of  Paris,  devised  machinery  by  which  the  alka- 
loids and  other  active  principles  were  thoroughly 


YELLOW  FEVER.  117 

triturated  with  sugar  of  milk  and  then  mechani- 
cally divided  into  mathematically  exact  doses 
and  shaped  into  granules,  thus  putting  into  the 
hands  of  the  physician  "arms  of  precision" 
upon  which  he  could  rely  implicitly  and  by 
which  he  might  secure  with  extreme  exactness 
any  physiological  or  therapeutical  effect  he 
desired. 

This  admirable  method  has  been  tried  by  a 
few  Brazilian  physicians  in  the  treatment  of 
yellow  fever,  though  not  in  accordance  with  my 
ideas  of  the  nature  of  the  disease.  But  as  I  am 
convinced  that  no  method  of  medication  or  any 
kind  of  medicine  will  have  any  effect  upon  the 
disease  in  those  rapid  cases  which  seem  to  be 
over-whelmed  by  the  poison  and  stricken  to  die 
in  a  short  time  in  spite  of  all  that  medical  art 
can  do  for  them,  so  I  should  ftot  expect  any 
better  success  from  the  use  of  this  method 
except  as  a  prophylactic  measure.  I  have  given 
dosimetry  ten  years  of  close,  careful  and  un- 
biased investigation  and  trial  in  all  the  acute 
diseases  which  prevail  in  this  southern  country; 
and  I  have  found  that  the  most  of  them  can  be 
prevented,  aborted,  or  jugulated  by  it — this  of 
course  depending  upon  the  time  treatment  is 
instituted.  Hence  we  may  reasonably  expect 
to  accomplish  the  first  result,  prevention  (which 
is  always  better  than  cure),  by  the  use  of  this 
method    during    an    epidemic    of    yellow    fever. 

There  seems  to  be  as  much  difference  of  opinion 


ii8  YELLOW   FEVEK. 

regarding  the  nature  of  the  disease  as  iheie  is 
regarding  its  cause;  and  this  accounts  for  the 
great  number  of  therapeutic  remedies  that  we 
find  advocated  in  its  treatment.  The  majority 
of  writers  claim  that  it  is  the  nervous  system 
which  is  first  attacked  by  the  poison  of  the  dis- 
ease; and  yet  at  the  same  time  they  inconsistently 
classify  it  among  the  zymotic  affections. 

Now  if  this  theory  of  its  cause  which  I  have 
been  advocating  is  true  (and  this  is  too  clearly 
and  perfectly  sustained  by  all  known  historical 
facts  concerning  the  disease  for  it  ever  to  be  suc- 
cessfully controverted)  then  it  ought  to  be  plain 
to  every  intelligent  investigator  that  the  specific 
infection  causing  yellow  fever  is  a  blood  poison, 
and  that  the  toxicohemia  is  the  result  of  a  virus 
or  animal  poison  which  introduced  into  the  cir- 
culating fluid  produces  septic  or  priitrescent 
effects  in  the  blood  which  is  the  point  of  in- 
vasion. This  is  strongly  sustained  by  the  fact 
that  putrefaction  takes  place  more  rapidly  after 
death  from  this  disease  than  any  other,  and  alfo 
by  the  so-called  black  vomit  which  is  far  more 
frequent  than  even  experienced  physicians  are 
aware  of;  for  I  do  not  recall  a  single  post- 
mortem that  I  ever  made  or  witnessed  in  which 
abundant  evidence  was  not  found  of  the  com- 
mencement of  this  change  or  decomposition  of 
the  blood,  although  in  many  no  evidence  of  it 
was  seen  during  life.  In  fact,  it  seems  to  me 
that  it  is  a  misnomer  to  speak  of  it  as  a  vomit; 


m 


YELLOW   FEVER.  1 19 

for  the  stomach  is  not  its  only  source  by  any 
means;  it  oozes  out  through  the  mucous  surfaces 
of  the  mouth,  throat,  oesophagus,  stomach  and 
intestinal  canal,  and  also  transudes  through  the 
weakened  and  distended  walls  of  the  blood 
vessels. 

You  who  have  had  much  experience  with  the 
disease  are  doubtless  familar  with  the  scene 
of  the  patient  every  now  and  then  throwing  his 
head  back  and  spurting  a  mouthful  of  the  horrid 
stuff  against  the  wall,  upon  the  floor,  the  bed  or 
upon  your  person,  or  even  into  your  face  if  you 
are  not  on  your  guard.  This  is  what  trickles 
down  from  the  gums  and  fauces  and  does  not 
come  from  the  stomach  at  all;  and  it  is  not  till 
there  is  an  accumulation  of  it  in  the  stomach 
that  it  is  vomited,  unless  that  organ  is  in  an  irrita- 
ble condition  and  vomiting  is  occurring  from 
other  causes. 

All  my  observations  before  and  after  death 
tend  to  confirm  the  opinion  that  it  is  the  blood 
which  is  first  invaded  and  affected  by  the  spe- 
cific poison  of  yellow  fever;  and  remembering 
that  the  blood  makes  the  round  of  the  circula- 
tion in  sixty  seconds,  or  a  little  less,  it  can  be 
understood  at  a  glance  how  easily  and  quickly 
the  nervous  system  as  well  as  all  the  tissues  and 
organs  of  the  body,  can  become  affected  and  all 
their  functions  deranged. 

I  have  said  that  I  should  not  expect  any  be  tter 
success  with  the  dosimetric  method  of  treatment 


I20  YELLOW  FKVER. 

of  yellow  fever  than  with  any  other,  except  as  a 
prophylactic  measure.     But  I  should   not  make 
such  a  sweeping  declaration  after  the  great  suc^ 
cess  I  have  had  with  it  during  the  last  ten  years 
of  my  active  practice,  for  Lhave  not  had  the  op- 
portunity of  trying  it  in  this  disease.     It  would  '^ 
afford  me  great  pleasure  to  have  the  opportunity 
of  treating,  according  to  this  method  as  a  cura-.  ' 
tive  measure,  one  hundred  typical   and  serious            , 
cases  of  yellow  fever  after   the  disease''  had    act-            I 
ually  commenced,  and  also  a  hundred  or  more 
non-immunes  by  the  same  method  as  a  prevent-           ^4 
ive  or   prophylactic  measure.      I  have  seen   all            -' 
other  infallible   (?)   prescriptions  and  vaunted 
prophylactics  tried  and  fail;  but  I  have  perfect          ^j 
confidence  that  the   dosimetric   method    would 
prove  a   success  as  aprophylactic  at  least;  and 
I  should  not  feel  that  I  was  experimenting  with          ^ 
human  life  in  trying  this  method  in  yellow  fever 
for  the  first  time,  especially  after  having  seen  ^11 
other  methods  tried  with  but  little  benefit. 

Moreover,  this  method  does  not   discard  any  -■ 

old  prescription  or  remedy  which  has  been  tried 
and  found   useful.     I   said    it    was    '^improved 
allopathy;"  it  is  more,   it  is  an  improved  method 
of  therapeutics.     And  while  it  is   a   very   plain 
and  simple  method,  yet  the  physician  who  would 
practice   it  successfully    must   become   a   good        :  -. 
therapeutist;  and  to  do  this    he   must  be  well        ^ 
versed   in    every   department   of   medicine,  and         >" 
also  be  a  close  observer  and  a  good   reasoner. 


YELLOW  FEVER.  121 

Besides  this,  whether  it  be  the  nervous  system 
or  the  blood  which  is  first  attacked,  this  method 
points  out  exactly  what  is  necessary  to  be  done 
in  either  case. 

As  all  schools  admit  that  prevention  is  better 
than  cure,  I  will,  from  my  experience  with  this 
method  as  a  prophylactic  in  other  serious  dis- 
eases, give  the  course  I  would  advise  all  non- 
immunes to  pursue — a  course  which  I  think  best 
calculated  to  prevent  the  disease  entirely,  or 
failing  in  that  to  at  least  so  modify  it  as  to  ren- 
der it  benign  and  innocuous.  Take  one  granule 
of  arseniate  of  strychnine,  gr.  1-134,  and  two 
granules  of  arseniate  (or  hydroferrocyanate)  of 
quinine,  gr.  1-6  each,  every  one  or  two  hours 
till  six  doses  are  taken  in  a  day.  At  the  same 
time  take  two  granules  of  calcium  sulphide,  gr. 
1-6,  five  or  six  times  a  day.  Take  no  purgatives, 
and  end  each  day  at  bed-time  by  taking  two 
granules  each  of  the  celebrated  dosimetric  trin- 
ity— arseniate  of  strychnine,  gr.  1-134;  aconitine, 
gr.  1-134;  and  digitalin,  gr.  1-67.  This  combi- 
nation will  help  nature  to  restore  the  vital  energy 
used  up  during  the  day,  equalize  the  circula- 
tion and  strengthen  the  heart's  action,  as  well 
as  procure  quiet,  restful  sleep.  Occasionally 
take,  what  Doctor  Burggraeve  calls  a  lavage  in- 
tesitnalej  a  teaspoonful  of  seidlitz  salt — Abbott's 
Saline  Laxative  (neutral  sulphate  of  magnesia 
in  effervescent  combination)  in  half  a  glassful 
of  water,  before  breakfast,  followed  by  sucking 


122  BELLOW  i^ EVER. 

the  juice  of  half  a  fresh^lemon.  This  will  carry 
off  the  previous  night's  accumulation  of  vitiated 
matters  and  mucus  from  the  mouth,  stomach 
and  intestines,  thus  preventing  foulness  of  the 
stomach  and  constipation.  This  general  pre- 
scription should  be  kept  up  for  ten  days  after 
entering  a  yellow-fever  infected  district,  and 
then  omitted  for  a  week;  but,  to  be  on  the  safe 
side  and  take  all  necessary  precautions,  I  would 
advise  non-immunes  to  take  during  this  inter- 
val two  granules  of  strychnine  hypophosphite, 
gr.  1-134;  and  two  or  three  tablets  of  Nuclein 
(Aulde),  two  drops  each,  four  times  a  day. 
These  will  sustain  vital  energy  and  repair  the 
waste  which  is  going  on  more  rapidly  than  un- 
der ordinary  circumstances,  and  will  thus  pre- 
vent the  entrance  of  any  pathogenic  microbes 
into  the  organism. 

The  foregoing  is  all  that  I  would  advise  in  the 
way  of  medication;  and  it  ought  to  be  kept  up 
for  the  first  month  or  six  weeks  of  exposure,  and 
at  intervals  during  the  entire  epidemic,  depend;- 
ing  upon  the  amount  of  labor  and  exposure  and 
fatigue  that  these  parties  have  to  undergo  in  the 
discharge  of  their  duties.  And  while  there  is 
apparently  a  great  deal  of  medicine  involved  in 
the  course,  judging  from  the  number  of  doses, 
yet,  when  summed  up,  the  aggregate  will  be 
found  to  be  an  extremely  small  amount — say 
about  twenty  grains  of  quinine  and  twenty  grains 
of  calcium   sulphide,  with  less  than  one  grain  of 


YELLOW  FEVER.  123 

Strychnine,  in  ten  days.  It  was  this  method,  es- 
pecially through  the  labors  of  Dr.  Fontaine, 
of  Barsur-Seine,  that  brought  the  sulphide  of 
calcium  so  prominently  into  use  as  a  remedy  in 
all  zymotic  diseases,  and  which  Dr  Burg- 
graeve  terms  ''the  parasiticide  par  excellence," 
while  he  has  named  the  arseniate  of  strychnine 
his  ''cheval  de  bataille.'' 

I  will  attempt  no  outline  of  what  my  curative 
treatment  of  yellow  fever  would  be  according  to 
this  method,  but  will  say  that  under  any  and  all 
methods  it  requires  no  potent  nerve  depressors, 
no  powerful  arterial  sedatives  nor  antiphlogistics 
of  any  kind;  for  it  is  from  the  beginning  a  terrible 
state  of  asthenia  with  a  tendency  to  rapid  de- 
struction and  putrefaction  throughout  the  whole 
organism,  and  requires  all  the  skill  and  all  the 
agents  of  our  art  to  counteract  it  and  to  sustain 
struggling  nature  with  nervo-vital  incitants,  ton- 
ics and  reconstructives^until  the  danger  is  passed. 

In  speaking  of  the  use  of  sulphide  of  calcium 
in  all  zymotic  diseases  I  did  not  mean  to  imply 
thereby  that  yellow  fever  belongs  to  that  class, 
though  I  have  been  guilty  of  so  doing  in  the  past 
simply  from  force  of  habit  and  because  it  has 
been  so  classified  by  nosologists  generally. 
This,  however,  is  an  error;  for  it  does  not  belong 
to  that  class  at  all.  It  is  essentially  a  septic 
fever  caused  by  the  introduction  of  a  specific, 
septic,  animal  poison  into  the  circulatory  system, 
thus  producing  a  true  blood  poisoning. 


124  YELLOW  FEVER. 

As  the  difference  between  zymotic  and  septic 
poisons  in  their  course,  action  and  effects  is  sel- 
dom mentioned  and  as  they  are  sometimes 
used  synonymously,  I  will  give  you  my  idea  of 
the  difference  between  them — an  idea  derived 
from  long  .  comparative  observation  of  the 
various  diseases  produced  by  them;  for  to 
my  mind  a  clear  comprehension  of  this  dif- 
ference greatly  aids  us  in  understanding  sev- 
eral disputed  points  in  regard  to  the  nature  of 
yellow  fever. 

The  zymotic  contagium — be  that  whatever  it 
is,  whether  vegetable  germ  or  zo-ospore — requires 
a  nidus  within  the  human  body  in  which  to  in- 
cubate and  then  hatch.  During  this  period  of 
incubation  no  appreciable  change  or  reaction 
follows  but  at  the  end  of  this  period,  which  is 
longer  or  shorter  according  to  whatever  the  dis- 
ease is,  the  pathogenic  virus  is  hatched  out,  and 
infects  the  whole  economy  at  once,  giving  rise 
to  general  symptoms  which  are  common  to 
all  diseases  of  the  class.  So  that  in  diseases  pro- 
duced by  zymotic  poisoning  there  are  three  dis- 
tinguishable stages:  first,  an  incubative  or  dor- 
mant stage  without  symptoms;  second,  a  stage 
of  hatching  and  general  infection  accompanied 
by  general  symptoms  common  to  all  of  that  class; 
third,  a  stage  in  which  the  specific  symptoms 
pathognomonic  of  that  disease  appear.  In 
measles  there  is  first  the  incubative  stage  last- 
ing from  ten  to  fourteen  days;    second,  the  ca- 


YELLOW   I^EviiJK.  125 

tarrhal  and  febrile,  three  to  four  days;  third,  the 
eruptive,  three  to  five  days. 

There  are  no  such  observable  stages  in  dis- 
eases produced  by  septic  poisoning;  for  these 
poisons  incubate  and  hatch  into  the  pathogenic 
virus  outside  of  the  body,  which  then  gains  en- 
trance into  the  body  through  the  natural  pas- 
sages by  being  inhaled  into  the  lungs  with  the 
air  breathed  and  swallowed  into  the  stomach 
with  the  liquids  and  foods  taken  by  the  indi- 
vidual in  a  locality  infected  by  the  virus.  In  the 
case  of  a  true  germ  disease,  like  yellow  fever, 
countless  myriads  of  the  pathogenic  microbes 
gain  entrance  thus  far;  but  the  vast  majority 
and  in  many  cases  all  of  them  are  destined  to  be 
destroyed  by  the  vital  energy  of  the  organism 
into  which  they  have  gained  entrance.  But 
,  when  they  once  meet  with  a  vulnerable  surface 

!  through  which   they  can  enter  the  blood-stream 

their  work  of  destruction  begins  and,  in  conse- 
quence of  the  rapidity  of  the  circulation,  reac- 
tion commences  and  the  whole  body  is  infected 
at  once  and  specific  symptoms  follow  imme- 
diately. 

The  next  general  difference  between  these  poi- 
sons is  that  in  septic  diseases  the  gravity,  vio- 
lence and  result  of  the  attack  depend  in  each 
case  upon  the  virulence  and  quantity  of  the  sep- 
tic poison  introduced;  while  in  zymotic  poison- 
ing this  makes  absolutely  no  difference  in  the 
violence  of  the  reaction  or  the  result. 


126  YELLOW   FEVER. 

Finally:  In  contagious,  zymotic  diseases  the 
disease-producing  germs  or  microbes  continue 
to  propagate  and  multiply  in  the  organism  which 
they  have  invaded  and  escape  from  that  organ- 
ism to  infect  others,  thus  causing  new  cases; 
whereas  the  septic  poison  reaches  the  limit  of 
its  existence  in  each  case  infected  and  is 
either  vanquished  and  cast  out  as  effete  matter; 
or  it  overwhelms  and  destroys  the  individual 
and,  Sampson-like  pulling  down  the  pillars  of 
life's  citadel,  is  involved  in  the  ruin  wrought  by 
it.  Hence,  as  a  rule,  septic  diseases  are  not 
contagious,  while  zymotic  diseases  are. 

This  explanation  of  the  principal  points  of 
difference  between  the  zymotic  and  septic  poi- 
sons enables  one  to  understand  easily  why  yel- 
low fever  is  not  contagious  from  the  person;  for 
the  pathogenic  bacilli,  after  accomplishing  their 
work,  perish  in  the  body  and  thereby  become 
innocuous;  and  as  they  do  not  multiply  or  propa- 
gate in  the  body  there  can  be  no  infectious  or 
contagious  emanations  from  that  body.  It  also 
enables  one  to  clearly  comprehend  how  and  why 
a  refugee  from  an  infected  district,  although  he 
may  not  have  the  disease  himself  and  may  even 
be  an  immune,  is  a  source  of  danger  to  others  if 
he  comes  to  them  in  the  same  suit  of  clothes 
which  he  wore  while  in  the  infected  district,  and 
particularly  when  he  brings  a  trunk  of  clothing 
packed  in  that  district. 

Thus  my  readers  will  be  enabled  to  understand 


YELLOW   FEVER.  127 

why  I  advocate  a  quarantine;  not  against  the 
person  of  the  refugee,  but-  against  his  clothing 
and  against  everything  he  brings  from  the  in- 
fected district  which  may  serve  as  fomites  for 
the  transmission  of  the  disease,  from  which  he  is 
fleeing.  • 


APPENDIX. 


Containing  a  parallel  table  of  the  principal 
characteristic  symptoms  of  Yellow  Fever-  and 
Dengue,  and  so  comparing  them  as  to  show  how 
a  differential  diagnosis  can  be  made  and  the  two 
diseases-  distinguished.  Also,  a  few  more  im- 
portant facts  and  data  which  were  unintention- 
ally omitted,  and  which  greatly  strengthen  the 
theory  of  the  origin  of  Yellow  Fever  and  all  the 
positions  and  predictions  concerning  the  disease, 
closing  the  whole  matter  by  a  repetition  of  how 
the  disease  may  be  eradicated. 


APPENDIX. 


There  are  a  number  of  reasons  which  impress 
me  with  a  sense  of  the  propriety  and  even  the 
necessity  of  closing  this  very  imperfect  history 
of  yellow  fever  with  a  short  chapter  upon  what 
is  frequently  termed  its  twin  sister — dengue,  a 
disease  equally  as  unique  and  mysterious  as  the 
former,  and  as  little  understood  by  the  pro- 
fession. 

Principal  among  these  reasons  are  :  First, 
the  position  I  took  in  reference  to  the  epidemic 
of  1897;  second,  since  dengue  is  frequently 
taken  for  yellow  fever,  scarlet  fever,  and  some 
other  diseases,  to  show  the  great  difference 
between  the  two  diseases;  and  third,  tg  acknowl- 
edge my  error,  if  I  was  wrong  last  year,  and  to 
show  how  it  was  possible  forme  to  have  been 
so,  thus  convincing  my  readers  that  I  am  not  in 
the  least  biased  or  governed  by  prejudice  or 
bigotry  but  am  desirous  that  truth  alone 
should  prevail  even  at  the  risk  of  my  being 
misunderstood. 

I  took  a  firm  stand  at  the  beginning  of  the 
alarm,  expressing  the  opinion  that  there  was 
not  and  would  not  be  a  case  of  yellow  fever 
in    Texas    this    year    (1897)    and    that    there 


132  APPENDIX. 


was  good  reason  for  doubticfg  that  the  disease         v#i 
then  prevailing  east  of  the  Mississippi  was  yel-  j^ 

low  fever.  I  have  always  been  very  decided  in 
my  diagnosis,  though  sometimes  slow  to  arrive  at 
one,  yet  have  always  been  open  to  conviction. 
In  the  earlier  years  of  my  practice,  during  the 
prevalence  of  an  epidemic  of  dengue,  I  once 
diagnosed  a  case  as  scarlatina  and  was  very 
confident  that  I  was   correct  until  convinced  of  -^ 

my  error  by  an  older   confrere  and  by  subse-  ! 

quent    events   in  the   course    of   the   epidemic. 
Then    I   candidly    confessed   my   mistake    and 
profited  by  it  afterwards.     I  have  since  known 
a  number  of  physicians  to  make  the  same  mis-        _^j 
take  who   would  not   be  convinced  by   all   the  3 

arguments  and  facts   that  could  be  brought  to   ~     v' 
bear  upon  the  points.     And  I  have  been  afraid 
that   the   official   experts   of   last   year    were    a.  j 

little  inclined  to  be  of  that  stubborn  class 
who  thought  it  beneath  the  dignity  of  their 
position  to  confess  that  it  was  possible  for  them 
to  err. 

Now,  although  I  was  not  in  active  practice  at 
the  time,  I  had  been  watching  closely  the  reports 
of  the  progress  and  course  of  the  dengue  (which 
so  far  as  I  can  learn  began  in  San  Antonio)  for 
a  month  or  more  prior  to  any  excitement  or  talk 
of  yellow  fever;  and  having  passed  through  a 
number   of  such  epidemics  and  listened  to  the  ■ 

disputes  and  arguments  of  members  of  the  pro- 
fession   as   to    what  it    was,   I    was    prepared 


APPENDIX.  133 

* 

to  hear  it  called  yellow  fever,  scarlatina  or 
almost  anything  else  calculated,  to  alarm  the 
people.  To  do  what  4  could  to  prevent  the 
frantic  stampede  which  I  knew  was  bound  to 
follow  the  report  of  the  official  experts  then  mak- 
ing investigations  in  Galveston,  I  wrote  several' 
short  articles  for  the  daily  paper  of  Navasota, 
Texas,  where  I  was  staying  temporarily,  advising 
the  people  to  remain  quietly  in  their  comfortable 
homes,  and  warning  them  that  they  were  liable 
to  contract  worse  diseases  in  their  huts  and 
camps  in  the  forest  to  which  they  were  preparing 
to  flee;  and  that  all  would  in  the  end  regret  this 
hasty  and  injudicious  step.  But  it  was  all  in 
vain;  I  was  a  comparative  stranger  and  my 
advice  was  unheeded.  And  they  all  had  the 
dengue,  from  which  they  were  fleeing,  far  worse 
than  they  could  have  had  it  had  they  remained 
at  home;  and  as  I  had  predicted  they  deeply 
regretted  not  doing  so.  Never  in  its  history  did 
yellow  fever  take  such  a  sweeping  course  as  was 
exhibited  by  this  epidemic  of  dengue.  And 
this  is  one  of  the  important  characteristics  dis- 
tinguishing it  from  yellow  fever;  ioi  dengue 
not  only  takes  in  cities,  towns  and  villages  but 
the  entire  region  which  it  has  invaded  and  in- 
cludes almost  the  whole  population  among  its 
victims,  seldom,  if  ever  ending-  fatally  as  a  dis- 
ease per  se.  Persons  who  have  had  previous 
attacks  of  dengue,  as  well  as  those  who  have  had 
yellow  fever,  are  equally  as  liable  to  dengue  as 


li^  APPENDIX. 

those  who  have  never  suffered  attacks  of  either. 
On  the  other  hand,  one  attack  of  yellow  fever  is 
protective  against  a  second  attack,  and  the  dis- 
ease, as  a  rule,  is  confined  to  the  large  cities  on 
the  seaboard  (though  occasionally  its  germs 
have  been  carried  in  fomities  by  railroads  into 
interior  towns);  but  its  spread  has  never  been 
of  an  extensive,  sweeping,  epidemic  character 
like  that  of  dengue  and  la  grippe. 

Another  fact  in  connection  with  this  last 
epidemic  is  contradictory  of  all  the  past  history 
of  yellow  fever;  namely,  that  eight  out  of  every 
ten  cases  discovered  and  diagnosed  as  yellow 
fever  in  Galveston,  with  nearly  as  many  in 
Houston,  all  recovered — an  unheard  of  and  un- 
precedented result  in  that  disease.  Neither  was 
there  any  further  infection  from  that  number 
oi  foci  in  the  two  cities,  nor  could  a  source  of 
infection  be  traced  in  a  single  one  of  these  cases; 
but  the  conclusion  of  the  officials  was  that  some- 
how it  must  have  slipped  in  with  the  dengue. 
How  I  wish  they  had  told  us  from  whence  came 
this  dengue  and  also  something  about  its  modes 
of  travel  and  transportation,  and  by  what  route 
it  invaded  our  State  ! 

The  foregoing,  I  think,  sufficiently  explains 
my  position  in  the  matter;  and  doubtless  ninety 
per  cent  of  the  physicians  of  Texas  agree  that  I 
was  correct,  for  subsequent  events  fully  sustained 
me.  Just  here  let  me  parallel  the  principal 
characteristics  and  symptoms  of  the  two  diseases. 


APPENDIX. 


135 


YELLOW    FEVER 


DENGUE 


(i)  Is  a  non-contagioas  (but 
highly  infectious)  epidemic,  non- 
eruptive  fever  of  only  one  par- 
oxysm lasting  from  thirty-six  to 
seventy-two  hours— a  disease  of 
but  two  stages. 


(2)  Cause:— A  specific,  septic, 
animal  poison  of  known  origin 
and  with  no  incubative  period  in 
the  person  affected. 

(3)  Onset:— As  a  rule__pccurs 
at  night  between  nine  p.  m^  and 
three  a.  m.,  with  no  prodrornic 
symptoms  except  a  few  honfs'  of 
exhilaration  or  stimulation  pre- 
ceding the  sudden  invasion. 

(4)  Course :— The  most  regular 
of  any  disease;  always  exhibiting 
characteristic  phenomena "pecul- 
iarily  its  own,  variable  only  in 
intensity. 

(5)  Tongue: — Clean,  except—a 
little  white  furr,  anH  with  edges 
reddened^— bec^oming_dry^r£ism 
and  cracked  in  the  second  stage. 

(6)  Eyes  deeply  injected,  tur- 
gid and  yellowish;  expression  oft- 
en fierce,  anxious  and  enquiring. 

(7)  Headache  frontal,  with  in- 
tense supraorbital  pain;  also  pain 
in  back  and  calves. 


(8)  The  face,  neck  and  upper 
part  of  chest  flushed,  puffy,  red- 
dish inclining  to  purple,  yielding 
later  to  an  orange  or  bronzed  as- 
pect caused  by  stagnation  of  the 
blood  m  superficial  arterial  cap- 
illaries. 

(9)  Hemorrhages  from  the 
gums,  cracked  tongue  and  all 
mucous  surfaces,  as  well  as  from 
kidneys,  uterus  and  stomach. 

(10)  Urine  frequently  albumin- 
ous, 30  to  40  per  cent.  Specific 
gravity  low— i.oio  to  1.012;  sup- 
pression common. 


(i)  Is  a  non-contagious  but  es- 
sentially infectious,  epidemic 
typically  eruptive  fever  of  two 
paroxysms  separated  by  a  short 
remission  lasting  in  all  five  days 
{\S:  the  second  paroxysm  is  not 
prevented). 

(2)  Cause: — Wholly  unknown, 
but  supposed  to  be  some  elec- 
trical disturbance  in  the  air  or 
earth;  closely  akin  to  la  grippe. 

(3)  Onset:— Usually  occurs  in 
the  daytime,  from  nine  a.  m.  to  3 
p.  m. ;  invasion  is  generally  sud- 
den, but  this  is  irregular  as  is 
everything  else  about  the  dis- 
ease. 

(4)  Course : — Very  erratic;  -  re- 
sembling varioloid  in  thermo- 
metric  records,  yellow  fever  in 
march  of  pulse  and  scarlatina  or 
measles  in  eruption 

(5)  Tongue :— Clean  but  red  in 
first  paroxysm;  becoming  thickly 
coated  and  enlarged  in  second, 
with  offensive  breath. 

(6)  Eyes  and  physiognomy  not 
peculiar,  or  simply  expressive  of 
the  intense  pain  being  endured. 

(7)  Headache  occipital  or  pari- 
etal, with  deep,  intense  pain  back 
of  the  eyes;  soreness  of  all  mus- 
cles; neuralgia  in  certain  nerves 
and  rheumatic  pains  in  all  the 
joints. 

(8)  Skin  flushed  bright  red  and 
eyes  suffused,  but  exhibiting  none 
of  the  other  variations  of  color 
seen  in  yellow  fever  resulting 
from  the  sluggish  movement  of 
blood  in  capillaries. 


(9)  No  hemorrhagic  tendency; 
occasionally  obstinate  epistazis 
and  sometiihes  hematuria. 


(10)  Albuminous  urine  rare; 
specific  gravity  high— x. 030  to 
1.063 — sugar  more  frequent  than 
albumin,  hut  only  temporary. 


136 


APPENDIX. 


-^ 


YELLOW    FEVER 


DENGUE 


(ii)  Muscular  prostration  very 
great;  convalescence  slow  and 
tedious;  relapses  frequent. 

(12)  One  attack  affords  almost 
certain  immunity  for  the  future. 


(13)  Mortality  very  great— 25 
to  66  2-3  per  cent. 

(14)  Apeculiar.putrescent  odor 
exhales  from  all  parts  of  the  body 
— more  pronounced  in  second 
stage  and  in  some  epidemics  than 
in  others. 

-  (15)    Liver,  stomach,  heart  and 
kidneys  affected. 


{16)  No  sequel,  except  oc- 
casionally swellings  of  lymphatic 
glands  in  neck,  axilla,  groin  and 
testicle. 


(11)  Muscular  prostration  shght;. 
convalescence  rapid;  little  ten-, 
dency  to  relapse. 

(12)  One  attack  affords  no  im- 
munity; rather  seems  to  predis- 
pose to  others. 

(13)  Mortality  nil  if  uncompli- 
cated and  not  overmedicated. 

(14)  No  odor  perceptible  ex- 
cept in  the  last  paroxysm  when  it 
is  from  the  stomach  and  bowels 
only  and  of  the  nature  of  sulphu- 
retted hydrogen. 

(15)  These  organs  show  no 
pathological  changes  unless  they 
have  been  previously  diseased. 


{16)    Frequently    followed 
boils  and  carbuncles. 


by 


Leaving  out  the  v^rant  of  parallelism  between 
the  pulse  and  temperature  in  yellow  fever,  the 
foregoing  constitutes  the  principal  characteristic 
symptoms  exhibited  by  the  two  diseases;  but  as 
I  have  said  there  is  no  one  single  symptom  yet 
discovered  that  can  be  said  to  be  truly  pathog- 
nomonic of  either.  It  is  only  by  grouping  the 
phenomena  constituting  each  disease  that  the 
observer  is  able  to  form  a  correct  diagnosis; 
but  it  soon  becomes  as  easy  for  the  educated 
and  critical  observer  to  diagnose  these  diseases 
by  this  means  and  to  distinguish  between  them 
and  all  other  diseases  as  it  is  easy  for  one  to 
recognize  and  distinguish  his  friends  and  inti- 
mate acquaintances  from  strangers  by  their  gen- 
eral personal  appearance  and  make-up. 


APPENDIX.  137 

But  I  will  close  by  endeavoring  to  show  how 
it  was  possible  for  me  to  have  been  in  error  in 
regard    to    last  year's    epidemic;  and,  if  so,   to 
show  that  my  error   was    simply  another  addi- 
tional incontestible  proof  that  I  am  correct  in  all 
my  positions  and  predictions  in  regard  to  that 
hitherto  terrible  scourge,  yellow  fever.     In  the 
first  place  I  must  insist   that  if.  the   few  cases 
diagnosed    as   yellow   fever,  in    Galveston  and 
Houston,  were  indeed  and  in  truth  genuine  yel- 
low fever,  then  ,  all   the   other   thousands  upon 
thousands  of  cases,  not  only  in  ''the  twin  cities 
by  the  sea"  but  also  all  those  in   every  interior 
town  and  village  of  this  state  as  well  as  all  east 
of  the  Mississippi,  were  bound   to  be  the  same 
disease — true    yellow    fever;  it   was    either  all 
dengue  or  all   yellow   fever.     There_  could  be 
no  other  rational   explanation  "or  reason  given 
why  this  supposed  epidemic  of  dengue  exhibited 
a  greater  resemblance  to  and  possessed  more  of 
the  pathognomonic  symptoms    of   yellow  fever 
than  it  ever  did  before.     And  if  it  is  true  that  it 
was  genuine  yellow  fever  and  not  dengue  at  all, 
then  I  repeat  what  I  said  in  a  paper  upon  this 
subject  in  The  A Ikaloidal  Clinic  oi  ]?iTL\i2iXyj  1898: 
''The  scourge  of  the  south   has   lost  its  malig- 
nancy;   its    death-dealing  fangs    have  been  ex- 
tracted, and  it  will  no  longer  be  dreaded   as  it 
has  been  in  the  past." 

I  will  now  show  how  this  is    simply  another 
strong  proof  of  the  truth  of  my  theory,  positions 


138  APPENDIX. 

and  predictions  as  set  forth  in  the  preceding 
pages  of  this  little  book.  And  it  should  require 
but  little  or  no  argument  or  explanation  to  es- 
tablish the  truth  of  this  last  assertion.  In  fact, 
it  is  only  what  would  be  naturally  expected  to 
occur,  according  to  the  past  history  of  the  dis- 
ease and  the  history  of  what  I  have  attempted 
to  prove  was  its  origin  and  cause,  the  African 
slave  trade.  And  before  closing  I  will  mention 
some  very  important  facts  which  I  have  strangely 
overlooked  and  omitted  to  give  in  their  proper 
order;  for  they,  are  as  strongly  corroborative 
and  confirmative  of  my  theory  as  anything  yet 
adduced. 

These  facts  are  as  follows  :  The  island  of  Cuba 
has  two  hundred  capacious  harbors  into  most  of 
which  ships  of  the  line  can  enter.  Slave  ships 
used  to  enter  them,  and  yellow  fever  prevailed 
there  as  long  as  that  was  the  case.  But  their  sit- 
uation and  openings  into  the  Gulf  were  such  that 
nature's  great  purifier— ^water— had  such  free  ac- 
cess and  egress  that  as  soon  as  those  vile  ships 
ceased  to  arrive  these  harbors  like  those  on  our 
Atlantic  seaboard  were  cleansed  by  the  natural 
action  of  the  waves  and  tides  and  yellow  fever 
ceased  to  prevail.  And  it  is  now  as  unknown  in 
the  interior  of  Cuba  as  it  is  in  Michigan  and  Illi- 
nois or  any  of  our  interior  states.  This  shows 
conclusively  that  it  did  not  originate  in  that 
island. 

I  think  I  have  succeeded  in  proving  satisfac- 


APPENDIX.   ^  139 

torily  that  since  the  complete  suppression  and 
removal  of  that  cause  the  disease  has  also  dis- 
appeared from  and  ceased  to  exist  in  all  parts 
of  the  world  where  it  had  prevailed  so  often  and 
so  virulently  during  the  existence  of  the  nefari- 
ous traffic,  except  from  that  filthy  little  pond — 
the  bay  of  Havana,  Cuba..  I  have  also  shown 
that  while  it  has  disappeared  from  all  the  other 
ports  of  the  West  Indies^  the  reason  why  it  has 
been  so  slow  in  disappearing  from  this  particu- 
lar harbor  is:  First,  that  it  has  always  been  the 
headquarters  for  slave  ships  from  the  inaugura- 
tion of  the  traffic  until  its  close;  and  hence  has 
received  into  its  mud  banks  a  larger  material 
quantity  of  the  peculiar  filth  than  has  any  other 
port;  second,  that  the  sluggishness  of  its  waters 
and  its  narrow  outlet  makes  it  almost  impossi- 
ble for  those  waters  to  be  completely  changed 
and  purified  without  the  help  of  man,  at  least  in 
any  reasonable  time;  third,  because  it  was  the 
last  point  on  the  globe  to  receive  accretions  of 
that  peculiar  filth  from  which  the  specific  poi- 
son of  the  disease  is  generated — slaves  having, 
according  to  the  best  authentic  accounts  I  can 
find,  been  landed  there  as  late  as  1876.  From 
this  it  will  be  seen  that  no  additions  of  this  filth 
had  been  made  to  its  mud  banks  for  twenty-two 
years;  consequently  the  slow  action  of  the  little 
tide  by  which  its  waters  are  affected  has  in  that 
time  so  diluted,  attenuated  and  carried  out  por- 
tions of  this  filth  that  it  can  no  longer  give  rise 


140  APPENDIX. 

to  the    virulent  type  of  yellow  fever  of  former 
days. 

Now  if  this  is  not  a  true  statement  of  the  condi- 
tion now  existing  in  the  harbor  of  Havana,  and  if 
the  viateries  morbi  of  yellow  fever  is  still  there 
in  all  of  its  original  potency  and  virulence,  then 
the  prophecies  and  predictions  of  the  croakers 
will  have  abundant  opportunity  for  fulfilment. 
For  since  the  treacherous  and  villianous  blowing 
up  of  our  peaceable  visitor — the  warship  Maine 
— the  stirring  up  of  that  filthy  mud,  theremoval 
of  all  quarantine  restrictions,  and  the  fleeing  of 
thousands  from  that  port  to  our  shores  (espec- 
ially at  this  particular  season)  will  all  be  the 
occasion  and  means  of  the  introduction  of  a 
greater  quantity  of  the  disease-producing  germs 
of  yellow  fever  than  ever  came  to  our  shores  in 
one  season  before.  And  if  they  possess  any  of 
the  old-time  vigor  and  virulence  of  the  yellow' 
fever  germs  of  forty  years  ago,  it  will  knock  my 
theory  into  a  cocked  hat  and  scatter  my  deduc- 
tions and  historical  data  to  the  four  winds  of 
heaven;  and  in  addition  to  the  horrors  of  a 
foreign  war  we  may  confidently  expect  our 
country  to  be  scourged  from  Texas  to  Maine 
and  from  the  Atlantic  to  the  Pacific  by  this  hor- 
rible plague. 

But  I  have  so  much  confidence  in  the  histori- 
cal data  which  I  have  furnished  in  regard  to  its 
cause,  and  am  so  well  assured  that  these  data 
rest  so  securely  upon  the  firm  basis  of  eternal 


APPENDIX, 


truth    that    they   cannot    be  overturned,    that 
have  no  fears  of  such  a  result. 

It  is  possible  that  I  am  a  little  premature  in 
my  predictions  and  that  the  virus  in  that  dirty 
little  pond  of  Havana  is  still  virulent  enough  to 
be  capable  of  producing  another  terrible  epi- 
demic. If  so,  then  the  sooner  my  suggestions 
are  adopted  the  better  it  will  be  for  humanity 
in  general. 

I  propose  to  cut  canals  and  turn  the  Gulf 
Stream  into  the  bay,  and  thus  wash  out  the  last 
traces  of  ''the  most  cruel  traffic  that  ever  visited 
any  American  port  from  Cape  Cod  to  the  Cape 
of  Florida — a  traffic  that  brought  in  its  train  a 
far-reaching  Nemesis  such  as  wrong-doing  never 
fails  to  bring." 

FINIS. 


